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Polinski KJ, Robinson SL, Putnick DL, Sundaram R, Bell E, Joseph PV, Segars J, Guan W, Silver RM, Schisterman EF, Mumford SL, Yeung EH. Examination of newborn DNA methylation among women with polycystic ovary syndrome/hirsutism. Epigenetics 2023; 18:2282319. [PMID: 37992405 PMCID: PMC10732621 DOI: 10.1080/15592294.2023.2282319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/06/2023] [Indexed: 11/24/2023] Open
Abstract
Research suggests that polycystic ovary syndrome (PCOS) traits (e.g., hyperandrogenism) may create a suboptimal intrauterine environment and induce epigenetic modifications. Therefore, we assessed the associations of PCOS traits with neonatal DNA methylation (DNAm) using two independent cohorts. DNAm was measured in both cohorts using the Infinium MethylationEPIC array. Multivariable robust linear regression was used to determine associations of maternal PCOS exposure or preconception testosterone with methylation β-values at each CpG probe and corrected for multiple testing by false-discovery rate (FDR). In the birth cohort, 12% (102/849) had a PCOS diagnosis (8.1% PCOS without hirsutism; 3.9% PCOS with hirsutism). Infants exposed to maternal PCOS with hirsutism compared to no PCOS had differential DNAm at cg02372539 [β(SE): -0.080 (0.010); FDR p = 0.009], cg08471713 [β(SE):0.077 (0.014); FDR p = 0.016] and cg17897916 [β(SE):0.050 (0.009); FDR p = 0.009] with adjustment for maternal characteristics including pre-pregnancy BMI. PCOS with hirsutism was also associated with 8 differentially methylated regions (DMRs). PCOS without hirsutism was not associated with individual CpGs. In an independent preconception cohort, total testosterone concentrations were associated with 3 DMRs but not with individual CpGs, though the top quartile of testosterone compared to the lowest was marginally associated with increased DNAm at cg21472377 near an uncharacterized locus (FDR p = 0.09). Examination of these probes and DMRs indicate they may be under foetal genetic control. Overall, we found several associations among newborns exposed to PCOS, specifically when hirsutism was reported, and among newborns of women with relatively higher testosterone around conception.
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Affiliation(s)
- Kristen J. Polinski
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Sonia L. Robinson
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Diane L. Putnick
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Rajeshwari Sundaram
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Erin Bell
- Department of Environmental Health Sciences, Epidemiology and Biostatistics, University at Albany School of Public Health, Albany, NY, United States
| | - Paule V. Joseph
- Section of Sensory Science and Metabolism, Division of Intramural Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
| | - James Segars
- Division of Reproductive Science and Women’s Health Research, Johns Hopkins Department of Gynecology & Obstetrics, Baltimore, MD, United States
| | - Weihua Guan
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Robert M. Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, United States
| | - Enrique F. Schisterman
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Sunni L. Mumford
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Edwina H. Yeung
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
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Meng Y, Thornburg LL, Hoeger KM, Núñez ZR, Kautz A, Evans AT, Wang C, Miller RK, Groth SW, O’Connor TG, Barrett ES. Association between sex steroid hormones and subsequent hyperglycemia during pregnancy. Front Endocrinol (Lausanne) 2023; 14:1213402. [PMID: 37766683 PMCID: PMC10520461 DOI: 10.3389/fendo.2023.1213402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/08/2023] [Indexed: 09/29/2023] Open
Abstract
Objective Sex steroid hormones may play a role in insulin resistance and glucose dysregulation. However, evidence regarding associations between early-pregnancy sex steroid hormones and hyperglycemia during pregnancy is limited. The primary objective of this study was to assess the relationships between first trimester sex steroid hormones and the subsequent development of hyperglycemia during pregnancy; with secondary evaluation of sex steroid hormones levels in mid-late pregnancy, concurrent with and subsequent to diagnosis of gestational diabetes. Methods Retrospective analysis of a prospective pregnancy cohort study was conducted. Medically low-risk participants with no known major endocrine disorders were recruited in the first trimester of pregnancy (n=319). Sex steroid hormones in each trimester, including total testosterone, free testosterone, estrone, estradiol, and estriol, were assessed using high-performance liquid chromatography and tandem mass spectrometry. Glucose levels of the 1-hour oral glucose tolerance test and gestational diabetes diagnosis were abstracted from medical records. Multivariable linear regression models were fitted to assess the associations of individual first trimester sex steroids and glucose levels. Results In adjusted models, first trimester total testosterone (β=5.24, 95% CI: 0.01, 10.46, p=0.05) and free testosterone (β=5.98, 95% CI: 0.97, 10.98, p=0.02) were positively associated with subsequent glucose concentrations and gestational diabetes diagnosis (total testosterone: OR=3.63, 95% CI: 1.50, 8.78; free testosterone: OR=3.69; 95% CI: 1.56, 8.73). First trimester estrone was also positively associated with gestational diabetes (OR=3.66, 95% CI: 1.56, 8.55). In mid-late pregnancy, pregnant people with gestational diabetes had lower total testosterone levels (β=-0.19, 95% CI: -0.36, -0.02) after adjustment for first trimester total testosterone. Conclusion Early-pregnancy sex steroid hormones, including total testosterone, free testosterone, and estrone, were positively associated with glucose levels and gestational diabetes in mid-late pregnancy. These hormones may serve as early predictors of gestational diabetes in combination with other risk factors.
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Affiliation(s)
- Ying Meng
- School of Nursing, University of Rochester, Rochester, NY, United States
| | - Loralei L. Thornburg
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Kathleen M. Hoeger
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Zorimar Rivera- Núñez
- Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, United States
| | - Amber Kautz
- Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Adam T. Evans
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Christina Wang
- Division of Endocrinology, Department of Medicine and Clinical and Translational Science Institue, The Lundquist Institute at Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, CA, United States
| | - Richard K. Miller
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Susan W. Groth
- School of Nursing, University of Rochester, Rochester, NY, United States
| | - Thomas G. O’Connor
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
- Department of Psychiatry, University of Rochester, Rochester, NY, United States
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, United States
- Wynne Center for Family Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Emily S. Barrett
- Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
- Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, United States
- Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
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Aggarwal M, Chakole S. Prevalence of Polycystic Ovarian Syndrome and Its Link to Obesity in Adolescent Girls. Cureus 2023; 15:e45405. [PMID: 37854752 PMCID: PMC10581327 DOI: 10.7759/cureus.45405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/16/2023] [Indexed: 10/20/2023] Open
Abstract
Polycystic ovarian syndrome (PCOS), also referred to as Stein-Leventhal syndrome, happens to be one of most common hormonal disorders found in females, causing large-sized ovaries with small cysts of non-ovulated oocytes in the outer medulla part of the ovary. Women suffering from PCOS often exhibit symptoms like oligomenorrhoea, elevated testosterone levels, acne, alopecia, hirsutism, sudden weight gain and many more. It can predispose a woman to developing infertility in future, and thus, difficulties in conceiving; due to the cystic changes in the ovaries, it results in anovulation and amenorrhea. The early symptoms of PCOS are being commonly observed nowadays in young women who are in their early 20s and those who are overweight or obese. The metabolic expression of PCOS increases with obesity. Obesity is a factor that is considered to contribute the most in the occurrence of various long-standing and non-transmissible illnesses apart from PCOS such as atherosclerosis, hypertension, diabetes, high blood cholesterol and even certain types of cancers. In obesity, there is an increase in the size and number of fat cells in the body. Obese and overweight young girls have a heightened likelihood of developing PCOS and its corresponding metabolic and reproductive health complications.
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Affiliation(s)
- Muskan Aggarwal
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swarupa Chakole
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Piltonen TT, Komsi E, Morin-Papunen LC, Korhonen E, Franks S, Järvelin MR, Arffman RK, Ollila MM. AMH as part of the diagnostic PCOS workup in large epidemiological studies. Eur J Endocrinol 2023; 188:547-554. [PMID: 37294941 DOI: 10.1093/ejendo/lvad065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/06/2023] [Accepted: 06/08/2023] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Previous studies have shown good correlation between polycystic ovarian morphology (PCOM) and serum anti-Müllerian hormone (AMH) levels. We evaluated the utility of AMH as a surrogate for PCOM as a part of the polycystic ovary syndrome (PCOS) diagnosis by describing how the use of different AMH cut-off values would change the prevalence of PCOS. METHODS A general population-based birth cohort study. Anti-Müllerian hormone concentrations were measured from serum samples taken at age 31 years (n = 2917) using the electrochemiluminescence immunoassay (Elecsys). Anti-Müllerian hormone data were combined with data on oligo/amenorrhoea and hyperandrogenism to identify women with PCOS. RESULTS The addition of AMH as a surrogate marker for PCOM increased the number of women fulfilling at least two PCOS features in accordance with the Rotterdam criteria. The prevalence of PCOS was 5.9% when using the AMH cut-off based on the 97.5% quartile (10.35 ng/mL) and 13.6% when using the recently proposed cut-off of 3.2 ng/mL. When using the latter cut-off value, the distribution of PCOS phenotypes A, B, C, and D was 23.9%, 4.7%, 36.6%, and 34.8%, respectively. Compared with the controls, all PCOS groups with different AMH concentration cut-offs showed significantly elevated testosterone (T), free androgen index (FAI), luteinizing hormone (LH), LH/follicle-stimulating hormone (FSH) ratio, body mass index (BMI), waist circumference, and homoeostatic model assessment of insulin resistance (HOMA-IR) values, as well as significantly decreased sex hormone-binding globulin (SHBG) values. CONCLUSIONS Anti-Müllerian hormone could be useful surrogate for PCOM in large data sets, where transvaginal ultrasound is not feasible, to aid the capturing of women with typical PCOS characteristics. Anti-Müllerian hormone measurement from archived samples enables retrospective PCOS diagnosis when combined with oligo/amenorrhoea or hyperandrogenism.
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Affiliation(s)
- Terhi T Piltonen
- Department of Obstetrics and Gynaecology, Medical Research Center Oulu, Research Unit of Clinical Medicine, University of Oulu and Oulu University Hospital, FI-90029, Oulu, Finland
| | - Elina Komsi
- Department of Obstetrics and Gynaecology, Medical Research Center Oulu, Research Unit of Clinical Medicine, University of Oulu and Oulu University Hospital, FI-90029, Oulu, Finland
| | - Laure C Morin-Papunen
- Department of Obstetrics and Gynaecology, Medical Research Center Oulu, Research Unit of Clinical Medicine, University of Oulu and Oulu University Hospital, FI-90029, Oulu, Finland
| | - Elisa Korhonen
- Department of Obstetrics and Gynaecology, Medical Research Center Oulu, Research Unit of Clinical Medicine, University of Oulu and Oulu University Hospital, FI-90029, Oulu, Finland
| | - Stephen Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, W12 0NN, London, United Kingdom
| | - Marjo-Riitta Järvelin
- Faculty of Medicine, Center for Life Course Health Research, University of Oulu, FI-90014, Oulu, Finland
- Unit of Primary Care, Oulu University Hospital, FI-90220, Oulu, Finland
- Department of Epidemiology and Biostatistics, School of Public Health, MRC Centre for Environment and Health, Imperial College London, W2 1PG, London, United Kingdom
- Department of Life Sciences, College of Health and Life Sciences, Brunel University London, UB8 3PH, London, United Kingdom
| | - Riikka K Arffman
- Department of Obstetrics and Gynaecology, Medical Research Center Oulu, Research Unit of Clinical Medicine, University of Oulu and Oulu University Hospital, FI-90029, Oulu, Finland
| | - Meri-Maija Ollila
- Department of Obstetrics and Gynaecology, Medical Research Center Oulu, Research Unit of Clinical Medicine, University of Oulu and Oulu University Hospital, FI-90029, Oulu, Finland
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Pesonen E, Nurkkala M, Niemelä M, Morin-Papunen L, Tapanainen JS, Jämsä T, Korpelainen R, Ollila MM, Piltonen TT. Polycystic ovary syndrome is associated with weight-loss attempts and perception of overweight independent of BMI: a population-based cohort study. Obesity (Silver Spring) 2023; 31:1108-1120. [PMID: 36855820 DOI: 10.1002/oby.23681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/25/2022] [Accepted: 11/23/2022] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Up to 70% of women with polycystic ovary syndrome (PCOS) have pre-obesity or obesity. The aim of this study was to investigate whether women with PCOS have more weight-loss attempts than women without PCOS, regardless of BMI. Moreover, women's weight perceptions in relation to previous weight-loss attempts were evaluated. METHODS A population-based birth cohort study included women with (n = 278) and without PCOS (control individuals, n = 1560) who were examined at ages 31 and 46 years with questionnaires and clinical examinations. RESULTS Women with PCOS had more weight-loss attempts compared with control individuals at age 31 (47% vs. 34%, p < 0.001) and 46 years (63% vs. 47%, p < 0.001). At age 46 years, PCOS was associated with multiple weight-loss attempts in the adjusted model (odds ratio: 1.43 [95% CI: 1.00-2.03], p = 0.05). The perception of having overweight was more prevalent in those with PCOS, even among participants with normal weight, at age 31 (PCOS 47% vs. control 34%, p = 0.014) and 46 years (PCOS 60% vs. control 39%, p = 0.001). CONCLUSIONS Women with PCOS were more likely to have experienced multiple weight-loss attempts and a perception of having overweight compared with control individuals, regardless of obesity status.
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Affiliation(s)
- Emilia Pesonen
- Department of Obstetrics and Gynecology, Research Unit of Clinical Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Marjukka Nurkkala
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Unit of Population Health, University of Oulu, Oulu, Finland
| | - Maisa Niemelä
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Laure Morin-Papunen
- Department of Obstetrics and Gynecology, Research Unit of Clinical Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juha S Tapanainen
- Department of Obstetrics and Gynecology, Research Unit of Clinical Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Timo Jämsä
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Raija Korpelainen
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Unit of Population Health, University of Oulu, Oulu, Finland
| | - Meri-Maija Ollila
- Department of Obstetrics and Gynecology, Research Unit of Clinical Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Terhi T Piltonen
- Department of Obstetrics and Gynecology, Research Unit of Clinical Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
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Piltonen T, Morin-Papunen L, Ollila MM, Tapanainen J, Arffman R, Järvelin MR, Franks S. Women self-reporting PCOS symptoms should not be overlooked. Hum Reprod 2023; 38:189-190. [PMID: 36433765 DOI: 10.1093/humrep/deac251] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Terhi Piltonen
- Department of Obstetrics and Gynaecology, Medical Research Center Oulu, PEDEGO Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Laure Morin-Papunen
- Department of Obstetrics and Gynaecology, Medical Research Center Oulu, PEDEGO Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Meri-Maija Ollila
- Department of Obstetrics and Gynaecology, Medical Research Center Oulu, PEDEGO Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Juha Tapanainen
- Department of Obstetrics and Gynaecology, Medical Research Center Oulu, PEDEGO Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland.,Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riikka Arffman
- Department of Obstetrics and Gynaecology, Medical Research Center Oulu, PEDEGO Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Marjo-Riitta Järvelin
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Unit of Primary Care, Oulu University Hospital, Oulu, Finland.,MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.,Department of Life Sciences, College of Health and Life Sciences, Brunel University London, London, UK
| | - Stephen Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
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7
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Pölönen J, Pinola P, Ronkainen J, Blakemore AI, Buxton JL, Tapanainen JS, Franks S, Piltonen TT, Sebert S, Morin-Papunen L. Polycystic ovary syndrome and leukocyte telomere length: cross-sectional and longitudinal changes. Eur J Endocrinol 2022; 187:651-661. [PMID: 36074951 PMCID: PMC9578080 DOI: 10.1530/eje-22-0462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 09/08/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Telomeres are DNA-protein complexes that protect chromosome ends from DNA damage and are surrogate biomarkers of cellular aging. Current evidence, almost entirely from cross-sectional observations, supports negative associations between leukocyte telomere length (LTL) and adverse lifestyle factors and cardiometabolic risk factors. Polycystic ovary syndrome (PCOS), the most common gynecological endocrine disorder, is associated with inflammation and oxidative stress, both factors associated with accelerated telomere attrition. We therefore hypothesized that LTL would be shorter and decrease more rapidly in women with PCOS in comparison to a control population. DESIGN This is a population-based cohort study comprising women of Northern Finland Birth Cohort 1966, with clinical examinations at ages 31 and 46. The sample included self-reported PCOS (age 31, n = 190; age 46, n = 207) and referent women (age 31, n = 1054; age 46, n = 1324) with data on LTL. METHODS The association between LTL and PCOS at ages 31 and 46 was analyzed by linear regression models adjusted for BMI, smoking, alcohol consumption and socioeconomic status at the corresponding age. RESULTS Women with PCOS had similar mean LTL at ages 31 and 46 (P > 0.4 for both). The mean LTL change between ages 31 and 46 did not differ between groups (P = 0.19). However, we observed a significant LTL attrition between ages 31 and 46 in the reference population (P < 0.001), but not in women with PCOS (P = 0.96). CONCLUSIONS This finding may suggest a difference in the LTL attrition rate in women with PCOS, an unexpected finding that might affect their risk of age-related disease. Further research is needed to clarify the underlying mechanisms.
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Affiliation(s)
- Johanna Pölönen
- Department of Obstetrics and Gynecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
| | - Pekka Pinola
- Department of Obstetrics and Gynecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
- Correspondence should be addressed to P Pinola or S Franks; or
| | - Justiina Ronkainen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Alex I Blakemore
- Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Jessica L Buxton
- Department of Biomolecular Sciences, School of Life Sciences, Pharmacy and Chemistry, Kingston University London, London, UK
| | - Juha S Tapanainen
- Department of Obstetrics and Gynecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Stephen Franks
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
- Correspondence should be addressed to P Pinola or S Franks; or
| | - Terhi T Piltonen
- Department of Obstetrics and Gynecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
| | - Sylvain Sebert
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Laure Morin-Papunen
- Department of Obstetrics and Gynecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
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Naghshband Z, Malini SS. Association of FTO gene variant rs9939609 with hyperandrogenemia and fasting glucose levels in South Indian women with polycystic ovarian syndrome. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2022. [DOI: 10.1186/s43042-022-00236-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Polycystic ovary syndrome (PCOS) is a common endocrine–metabolic disorder due to genetic and environmental factors. Genetic variants located in intron 1 of Fat mass and obesity-associated (FTO) gene are associated with increased risk of obesity and metabolic disorders. This study aims to investigate the association of common FTO polymorphism rs9939609 in South Indian women with PCOS to assess its association with metabolic and endocrine parameters. FTO genotyping was done on 100 PCOS patients and 70 controls by Sanger sequencing.
Results
The distribution of rs9939609 was observed between groups (28% TT, 57% TA, and 15% AA for PCOS and 37.1% TT, 51.4% TA, and 11.4% AA for the controls). In the PCOS group, across the carriers of different genotypes, a significant association was found between body mass index (BMI), fasting glucose levels, and testosterone with the presence of at least one risk allele of FTO rs9939609. Logistic regression analysis showed the association of fasting glucose levels and testosterone (OR 1.30 [1.03–1.63] and OR 5.83 [1.61–21.11], respectively) with FTO rs9939609.
Conclusions
Our findings indicated that FTO SNP rs9939609 was not associated with PCOS, but suggested a significant association of rs9939609 with hyperandrogenemia, fasting glucose levels, and BMI in South Indian women with PCOS.
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A population-based follow-up study shows high psychosis risk in women with PCOS. Arch Womens Ment Health 2022; 25:301-311. [PMID: 34841466 PMCID: PMC8921102 DOI: 10.1007/s00737-021-01195-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting up to 18% of women. Besides metabolic and fertility aspects, attention has lately been directed towards the detrimental effect of PCOS on psychological health. The objective of the study was to investigate whether women with PCOS are at higher risk for psychotic disorders. The study population derives from the Northern Finland Birth Cohort 1966 (N = 5889 women). The women with PCOS were identified by two simple questions on oligo-amenorrhea and hirsutism at age 31. Women reporting both symptoms were considered PCOS (N = 124) and asymptomatic women as controls (N = 2145). The diagnosis of psychosis was traced using multiple national registers up to the year 2016. Symptoms of psychopathology were identified using validated questionnaires at age 31. Women with PCOS showed an increased risk for any psychosis by age 50 (HR [95% CI] 2.99, [1.52-5.82]). Also, the risk for psychosis after age 31 was increased (HR 2.68 [1.21-5.92]). The results did not change after adjusting for parental history of psychosis, nor were they explained by body mass index or hyperandrogenism at adulthood. The scales of psychopathology differed between women with PCOS and non-PCOS controls showing more psychopathologies among the affected women. PCOS cases were found to be at a three-fold risk for psychosis, and they had increased psychopathological symptoms. PCOS should be taken into consideration when treating women in psychiatric care. More studies are required to further assess the relationship between PCOS and psychotic diseases.
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Prete A, Auchus RJ, Ross RJ. Clinical advances in the pharmacotherapy of congenital adrenal hyperplasia. Eur J Endocrinol 2021; 186:R1-R14. [PMID: 34735372 PMCID: PMC8679847 DOI: 10.1530/eje-21-0794] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/04/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patients with 21-hydroxylase deficiency congenital adrenal hyperplasia (21OHD-CAH) have poor health outcomes with increased mortality, short stature, impaired fertility, and increased cardiovascular risk factors such as obesity. To address this, there are therapies in development that target the clinical goal of treatment, which is to control excess androgens with an adrenal replacement dose of glucocorticoid. METHODS Narrative review of publications on recent clinical developments in the pharmacotherapy of congenital adrenal hyperplasia. SUMMARY Therapies in clinical development target different levels of the hypothalamo-pituitary-adrenal axis. Two corticotrophin-releasing factor type 1 (CRF1) receptor antagonists, Crinecerfont and Tildacerfont, have been trialled in poorly controlled 21OHD-CAH patients, and both reduced ACTH and androgen biomarkers while patients were on stable glucocorticoid replacement. Improvements in glucocorticoid replacement include replacing the circadian rhythm of cortisol that has been trialled with continuous s.c. infusion of hydrocortisone and Chronocort, a delayed-release hydrocortisone formulation. Chronocort optimally controlled 21OHD-CAH in 80% of patients on an adrenal replacement dose of hydrocortisone, which was associated with patient-reported benefits including restoration of menses and pregnancies. Adrenal-targeted therapies include the steroidogenesis-blocking drug Abiraterone acetate, which reduced adrenal androgen biomarkers in poorly controlled patients. CONCLUSIONS CRF1 receptor antagonists hold promise to avoid excess glucocorticoid replacement in patients not controlled on standard or circadian glucocorticoid replacement such as Chronocort. Gene and cell therapies are the only therapeutic approaches that could potentially correct both cortisol deficiency and androgen excess.
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Affiliation(s)
- Alessandro Prete
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard J Auchus
- Division of Metabolism, Endocrinology and Diabetes, Departments of Pharmacology and Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard J Ross
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Correspondence should be addressed to R J Ross;
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Tuorila K, Ollila MM, Järvelin MR, Tapanainen JS, Franks S, Puukka K, Piltonen TT, Morin-Papunen L. Hyperandrogenemia in Early Adulthood Is an Independent Risk Factor for Abnormal Glucose Metabolism in Middle Age. J Clin Endocrinol Metab 2021; 106:e4621-e4633. [PMID: 34153097 PMCID: PMC8530724 DOI: 10.1210/clinem/dgab456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT The role of androgen excess as a contributing factor to abnormal glucose metabolism (AGM) and insulin resistance in women remains controversial. OBJECTIVE To investigate whether hyperandrogenemia (HA) estimated by serum testosterone (T) level and free androgen index (FAI) at ages 31 and 46 years is associated with insulin resistance, insulin secretion and AGM by age 46. DESIGN Prospective study including 5889 females followed at ages 31 and 46 years. SETTING General community. PARTICIPANTS Women with HA were compared with normoandrogenic women at ages 31 and 46 years. INTERVENTION None. MAIN OUTCOME MEASUREMENTS AGM, including prediabetes and type 2 diabetes mellitus, homeostatic model assessments of insulin resistance (HOMA-IR) and of pancreatic β-cell function (HOMA-B). RESULTS At age 31 years, HA women displayed increased HOMA-IR (P = 0.002), HOMA-B (P = 0.007), and higher fasting insulin (P = 0.03) than normoandrogenic women after adjusting for body mass index (BMI). At age 46 years, there was a nonsignificant trend toward higher fasting glucose (P = 0.07) and glycated hemoglobin A1 (P = 0.07) levels in HA women. Women in the highest T quartile (odds ratio [OR] = 1.80; 95%CI, 1.15-2.82) at age 31 years and in the 2 highest FAI quartiles at ages 31 (Q4: OR = 3.76; 95% CI, 2.24-6.32) and 46 (Q4: OR = 2.79; 95% CI, 1.74-4.46) years had increased risk for AGM, independently of BMI, when compared with women in Q1. SHBG was inversely associated with AGM (at age 31 years: Q4: OR = 0.37; 95% CI, 0.23-0.60, at age 46 years: Q4: OR = 0.28; 95% CI, 0.17-0.44). CONCLUSION Hyperandrogenemia and low SHBG in early and middle age associates with AGM independently of BMI.
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Affiliation(s)
- Katri Tuorila
- Department of Obstetrics and Gynecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
| | - Meri-Maija Ollila
- Department of Obstetrics and Gynecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
| | - Marjo-Riitta Järvelin
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Unit of Primary Health Care, Oulu University Hospital, OYS, Oulu, Finland
- Department of Life Sciences, College of Health and Life Sciences, Brunel University London, London, UK
| | - Juha S Tapanainen
- Department of Obstetrics and Gynecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Stephen Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Katri Puukka
- NordLab Oulu, Department of Clinical Chemistry, University of Oulu and Oulu University Hospital, Medical Research Center Oulu, Oulu, Finland
| | - Terhi T Piltonen
- Department of Obstetrics and Gynecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
| | - Laure Morin-Papunen
- Department of Obstetrics and Gynecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
- Correspondence: Laure Morin-Papunen, MD, PhD, Department of Obstetrics and Gynecology, Oulu University Hospital, PL 23 90029 OYS, Finland.
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Rezq S, Huffman AM, Basnet J, Yanes Cardozo LL, Romero DG. Cardiac and Renal SARS-CoV-2 Viral Entry Protein Regulation by Androgens and Diet: Implications for Polycystic Ovary Syndrome and COVID-19. Int J Mol Sci 2021; 22:ijms22189746. [PMID: 34575910 PMCID: PMC8470275 DOI: 10.3390/ijms22189746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 12/31/2022] Open
Abstract
The susceptibility and the severity of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are associated with hyperandrogenism, obesity, and preexisting pulmonary, metabolic, renal, and cardiac conditions. Polycystic ovary syndrome (PCOS), the most common endocrine disorder in premenopausal women, is associated with obesity, hyperandrogenism, and cardiometabolic dysregulations. We analyzed cardiac, renal, circulatory, and urinary SARS-CoV-2 viral entry proteins (ACE2, TMPRSS2, TMPRSS4, furin, cathepsin L, and ADAM17) and androgen receptor (AR) expression, in a peripubertal androgen exposure model of PCOS. Peripubertal female mice were treated with dihydrotestosterone (DHT) and low (LFD) or high (HFD) fat diet for 90 days. HFD exacerbated DHT-induced increase in body weight, fat mass, and cardiac and renal hypertrophy. In the heart, DHT upregulated AR protein in both LFD and HFD, ACE2 in HFD, and ADAM17 in LFD. In the kidney, AR protein expression was upregulated by both DHT and HFD. Moreover, ACE2 and ADAM17 were upregulated by DHT in both diets. Renal TMPRSS2, furin, and cathepsin L were upregulated by DHT and differentially modulated by the diet. DHT upregulated urinary ACE2 in both diets, while neither treatment modified serum ACE2. Renal AR mRNA expression positively correlated with Ace2, Tmprss2, furin, cathepsin L, and ADAM17. Our findings suggest that women with PCOS could be a population with a high risk of COVID-19-associated cardiac and renal complications. Furthermore, our study suggests that weight loss by lifestyle modifications (i.e., diet) could potentially mitigate COVID-19-associated deleterious cardiorenal outcomes in women with PCOS.
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Affiliation(s)
- Samar Rezq
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, 2500 N, State Street, Jackson, MS 39216, USA; (S.R.); (A.M.H.); (J.B.); (L.L.Y.C.)
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, 2500 N, State Street, Jackson, MS 39216, USA
- Women’s Health Research Center, University of Mississippi Medical Center, 2500 N, State Street, Jackson, MS 39216, USA
- Cardio Renal Research Center, University of Mississippi Medical Center, 2500 N, State Street, Jackson, MS 39216, USA
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Alexandra M. Huffman
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, 2500 N, State Street, Jackson, MS 39216, USA; (S.R.); (A.M.H.); (J.B.); (L.L.Y.C.)
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, 2500 N, State Street, Jackson, MS 39216, USA
- Women’s Health Research Center, University of Mississippi Medical Center, 2500 N, State Street, Jackson, MS 39216, USA
- Cardio Renal Research Center, University of Mississippi Medical Center, 2500 N, State Street, Jackson, MS 39216, USA
| | - Jelina Basnet
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, 2500 N, State Street, Jackson, MS 39216, USA; (S.R.); (A.M.H.); (J.B.); (L.L.Y.C.)
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, 2500 N, State Street, Jackson, MS 39216, USA
- Women’s Health Research Center, University of Mississippi Medical Center, 2500 N, State Street, Jackson, MS 39216, USA
- Cardio Renal Research Center, University of Mississippi Medical Center, 2500 N, State Street, Jackson, MS 39216, USA
| | - Licy L. Yanes Cardozo
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, 2500 N, State Street, Jackson, MS 39216, USA; (S.R.); (A.M.H.); (J.B.); (L.L.Y.C.)
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, 2500 N, State Street, Jackson, MS 39216, USA
- Women’s Health Research Center, University of Mississippi Medical Center, 2500 N, State Street, Jackson, MS 39216, USA
- Cardio Renal Research Center, University of Mississippi Medical Center, 2500 N, State Street, Jackson, MS 39216, USA
- Department of Medicine, University of Mississippi Medical Center, 2500 N, State Street, Jackson, MS 39216, USA
| | - Damian G. Romero
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, 2500 N, State Street, Jackson, MS 39216, USA; (S.R.); (A.M.H.); (J.B.); (L.L.Y.C.)
- Mississippi Center of Excellence in Perinatal Research, University of Mississippi Medical Center, 2500 N, State Street, Jackson, MS 39216, USA
- Women’s Health Research Center, University of Mississippi Medical Center, 2500 N, State Street, Jackson, MS 39216, USA
- Cardio Renal Research Center, University of Mississippi Medical Center, 2500 N, State Street, Jackson, MS 39216, USA
- Correspondence: ; Tel.: +1-601-984-1523; Fax: +1-601-984-1501
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13
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Piltonen TT, Arffman RK, Joham AE. Natural History of Polycystic Ovary Syndrome and New Advances in the Epidemiology. Semin Reprod Med 2021; 39:94-101. [PMID: 34464984 DOI: 10.1055/s-0041-1735211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women, affecting up to 15% of the female population. The natural history of the syndrome is complex, including both androgen exposure in early life and adiposity-driven dysfunction involving also dysregulated, also involving altered hypothalamus-ovarian crosstalk. The manifestations can arise as early as childhood or puberty onward, suggesting that genetic susceptibility is an important etiological factor. In adulthood, women with PCOS present with reproductive, metabolic, and psychological health issues at a population-based level. Epidemiological studies on large datasets offer an excellent opportunity to evaluate health effects and costs related to the syndrome. Hospital or insurance-based datasets are also available; however, the results are not representative of the female population in the community. More longitudinal studies spanning from early childhood to late adulthood are needed to assess the long-term health impact and early manifestations of PCOS. Moreover, the identification of women with PCOS from large datasets can be expensive. Self-reported symptoms or PCOS diagnosis may offer a feasible approach.
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Affiliation(s)
- Terhi T Piltonen
- PEDEGO Research Unit, Department of Obstetrics and Gynecology, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Riikka K Arffman
- PEDEGO Research Unit, Department of Obstetrics and Gynecology, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Anju E Joham
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Diabetes and Vascular Medicine, Monash Health, Melbourne, Australia
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Laru J, Nedelec R, Koivuaho E, Ojaniemi M, Järvelin MR, Tapanainen JS, Franks S, Tolvanen M, Piltonen TT, Sebert S, Morin-Papunen L. BMI in childhood and adolescence is associated with impaired reproductive function-a population-based cohort study from birth to age 50 years. Hum Reprod 2021; 36:2948-2961. [PMID: 34364312 PMCID: PMC8643422 DOI: 10.1093/humrep/deab164] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 06/08/2021] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What is the association between childhood and adolescent BMI and reproductive capacity in women? SUMMARY ANSWER Adolescent girls with obesity had an increased risk of infertility and childlessness in adulthood independently of their marital status or the presence of polycystic ovary syndrome (PCOS). WHAT IS KNOWN ALREADY Girls with obesity (BMI (kg/m2)>95th percentile) more often exhibit menstrual irregularities and infertility problems as compared to those with normal weight, and premenarcheal girls with obesity have an increased risk of childlessness and infertility in adulthood. Follow-up studies on the relation between childhood and adolescence growth patterns and fertility or parity throughout the reproductive life span are limited. STUDY DESIGN, SIZE, DURATION A prospective, population-based cohort study (the Northern Finland birth cohort 1966) was performed with 5889 women born in 1966 and followed from birth to age 50 years. Postal questionnaires at ages 31 and 46 years addressed questions on reproductive capacity evaluated by decreased fecundability, need for infertility assessment and treatment by 46 years of age. Childlessness and number of children by age 50 years were recovered from registers. Women who did not report ever having attempted to achieve pregnancy (n = 1507) were excluded. The final study population included 4382 women who attempted to achieve pregnancy before age 46 years. PARTICIPANTS/MATERIALS, SETTING, METHODS Data on BMI were collected by trained personnel at all stages. We assessed association with both prospectively measured BMI at various time points and with early adiposity phenotypes derived from linear mixed models including the timing and the BMI at adiposity peak (AP) and adiposity rebound (AR). Self-reported infertility assessments and treatments were assessed at ages 31 and 46 years. Data on deliveries were collected from the national birth register. Decreased fecundability was defined at age 31 years as time to achieve pregnancy over 12 months. Logistic regression analyses were conducted with adjustments for marital status, education level and smoking at age 31 years. Women with PCOS were excluded from stratification-based sensitivity analyses. Obesity at a specific age group was defined by having at least one BMI value above the 95th percentile during the related period. MAIN RESULTS AND THE ROLE OF CHANCE BMI at the age of AR (5-7 years) was not associated with fertility outcomes after adjustments, but girls with AR <5.1 years had a higher risk of remaining childless compared to girls with AR over 5.1 years (adjusted odds ratio (OR): 1.45 (1.10-1.92)). At ages 7-10 and 11-15 years, obesity was associated with decreased fecundability (adjusted OR 2.05 (1.26-3.35) and 2.04 (1.21-3.44), respectively) and a lower number of children. At age 11-15 years, both overweight and obesity were associated with a higher risk of childlessness (adjusted OR 1.56 (1.06-2.27), 1.77 (1.02-3.07), respectively), even after excluding women with PCOS. Underweight at age 11-15 years was associated with an increased risk for infertility treatment (adjusted OR 1.55 (1.02-2.36)) and a tendency for an increased risk for infertility assessment (adjusted OR 1.43 (0.97-2.10)) after excluding women with PCOS. LIMITATIONS, REASON FOR CAUTION Despite a high participation rate throughout the follow-up, some growth data for children over the different age groups were missing. Infertility outcomes were self-reported. A potential over-diagnosis of obesity may have reduced the significance of the association between childhood obesity and fertility outcomes, and the diagnosis of PCOS was self-reported. WIDER IMPLICATIONS OF THE FINDINGS This study supports previous results showing that girls with obesity in late childhood and in adolescence displayed reduced fertility and an increased risk of remaining childless in adulthood, independently of marital history and PCOS in adulthood. These findings corroborate the body of evidence for a causal relation between early adiposity and the reproductive functions in women. We recommend reinforcing the prevention of obesity in school-age girls to reduce the risk of impaired reproductive functions. STUDY FUNDING/COMPETING INTEREST(S) NFBC1966 received financial support from University of Oulu Grant no. 65354, Oulu University Hospital Grant no. 2/97, 8/97, Ministry of Health and Social Affairs Grant no. 23/251/97, 160/97, 190/97, National Institute for Health and Welfare, Helsinki Grant no. 54121, Regional Institute of Occupational Health, Oulu, Finland Grant no. 50621, 54231. The Finnish Medical Foundation, the North Ostrobothnia Regional Fund, the Academy of Finland (project grants 315921, 104781, 120315, 129269, 1114194, 24300796), Center of Excellence in Complex Disease Genetics and SALVE, the Sigrid Juselius Foundation, Biocenter Oulu, University Hospital Oulu and University of Oulu (75617), Jalmari ja Rauha Ahokkaan säätiö, The Finnish Medical Foundation, Medical Research Center Oulu, National Institute for Health Research (UK). M. R. J., S. S. and R. N. received funding by the Academy of Finland (#268336) and the European Union's Horizon 2020 research and innovation program (under Grant agreement no. 633595 for the DynaHEALTH action and GA 733206 for LifeCycle). The funders had no role in study design, in the collection, analysis and interpretation of the data, in the writing of the article and in the decision to submit it for publication. The authors have no conflict of interest to disclose. TRIAL REGISTRATION NUMBER N/A.
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Grants
- 54121 Department of Health
- Medical Research Council
- University of Oulu
- Oulu University Hospital
- Ministry of Health and Social Affairs
- National Institute for Health and Welfare, Helsinki
- Regional Institute of Occupational Health, Oulu, Finland
- The Finnish Medical Foundation, the North Ostrobothnia Regional Fund, the Academy of Finland
- Center of Excellence in Complex Disease Genetics and SALVE, the Sigrid Juselius Foundation, Biocenter Oulu, University Hospital Oulu and University of Oulu
- Jalmari ja Rauha Ahokkaan säätiö
- The Finnish Medical Foundation, Medical Research Center Oulu, National Institute for Health Research (UK)
- Academy of Finland
- European Union’s Horizon 2020 research and innovation program
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Affiliation(s)
- J Laru
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
| | - R Nedelec
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - E Koivuaho
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
| | - M Ojaniemi
- Department of Children and Adolescents, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
| | - M -R Järvelin
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Department of Life Sciences, College of Health and Life Sciences, Brunel University London, London, UK
- Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - J S Tapanainen
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - S Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - M Tolvanen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - T T Piltonen
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
| | - S Sebert
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - L Morin-Papunen
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
- Correspondence address. PEDEGO Research Unit, Department of Obstetrics and Gynecology, Medical Research Center, Oulu University Hospital, University of Oulu, Kajaanintie 50, BOX 5000, 90014 Oulu, Finland. Tel: +358 8 3154109; E-mail: https://orcid.org/0000-0001-5987-7534
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Lingaiah S, Arffman RK, Morin-Papunen L, Tapanainen JS, Piltonen T. Markers of gastrointestinal permeability and dysbiosis in premenopausal women with PCOS: a case-control study. BMJ Open 2021; 11:e045324. [PMID: 34226215 PMCID: PMC8258572 DOI: 10.1136/bmjopen-2020-045324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Altered intestinal permeability and gut barrier dysfunction have been suggested to play a role in the pathogenetic mechanism of polycystic ovary syndrome (PCOS), the most common endocrine and metabolic condition in reproductive-aged women. However, data on intestinal permeability and dysbiosis of the gut microbiota in PCOS is still limited, with conflicting results. To this end, the concentrations of gastrointestinal permeability and gut dysbiosis markers were analysed in women with PCOS. DESIGN Case-control study. SETTING General community. PARTICIPANTS 104 women with PCOS and 203 body mass index (BMI) matched control women at age 46. PRIMARY AND SECONDARY OUTCOME MEASURES Serum levels of zonulin, fatty acid-binding protein 2 (FABP2), urinary levels of indican, and hormonal and metabolic parameters. RESULTS Serum levels of zonulin (128.0±17.0 vs 130.9±14.0 ng/mL, p=0.13) and FABP2 (1.5±0.9 vs 1.5±0.7 ng/mL, p=0.63) and urinary levels of indican (9.5±5.5 vs 8.4±4.2 mg/dL, p=0.07) were comparable in women with PCOS and controls in the whole study population. Likewise, when the study population was divided into different BMI groups as normal weight, overweight and obese, the levels of the above markers were comparable between the study groups. After BMI adjustment, zonulin levels correlated with the levels of high-sensitivity C reactive protein and homoeostasis model assessment of insulin resistance (p<0.05) both in women with PCOS and controls. CONCLUSIONS Intestinal permeability markers zonulin and FABP2, and the dysbiosis marker indican do not seem to be altered in women with PCOS at age 46 compared with BMI-matched controls. Serum zonulin levels correlated with BMI, insulin resistance and inflammatory marker levels, but did not segregate women with PCOS and controls. This suggests that metabolic factors, but not PCOS per se, is the driving force of dysbiosis in premenopausal women with PCOS.
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Affiliation(s)
- Shilpa Lingaiah
- Department of Obstetrics and Gynaecology, PEDEGO Research Unit, Medical Research Centre, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Riikka K Arffman
- Department of Obstetrics and Gynaecology, PEDEGO Research Unit, Medical Research Centre, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Laure Morin-Papunen
- Department of Obstetrics and Gynaecology, PEDEGO Research Unit, Medical Research Centre, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Juha S Tapanainen
- Department of Obstetrics and Gynaecology, PEDEGO Research Unit, Medical Research Centre, Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Terhi Piltonen
- Department of Obstetrics and Gynaecology, PEDEGO Research Unit, Medical Research Centre, Oulu University Hospital, University of Oulu, Oulu, Finland
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Paalanne M, Vääräsmäki M, Mustaniemi S, Tikanmäki M, Wehkalampi K, Matinolli HM, Eriksson J, Järvelin MR, Morin-Papunen L, Kajantie E. Clinical and biochemical signs of polycystic ovary syndrome in young women born preterm. Eur J Endocrinol 2021; 185:279-288. [PMID: 34081616 PMCID: PMC8284903 DOI: 10.1530/eje-20-1462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 06/03/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE It has been suggested that adverse early life exposures increase the risk of developing polycystic ovary syndrome (PCOS) in later life. We hypothesized that women born preterm would have more biochemical and clinical signs of PCOS than women born at term. DESIGN The ESTER Preterm Birth Study participants were born in Northern Finland and identified from the Northern Finland Birth Cohort and the Finnish Medical Birth Register. Altogether, 74 women born very or moderately preterm (<34 gestational weeks, VMPT), 127 born late preterm (at 34-36 weeks, LPT), and 184 born full term (≥37 weeks, controls) were included in the analysis (mean age: 23.2 years). METHODS We measured serum total testosterone and sex hormone-binding globulin (SHBG) and calculated the free androgen index (FAI). PCOS according to the clinical and biochemical signs was defined either as hirsutism and oligoamenorrhea (via questionnaire) or as oligoamenorrhea and elevated testosterone levels (>2.4 nmol/L). RESULTS Women born VMPT/LPT exhibited 33.0% (8.7, 62.8)/16.4% (-2.0, 38.1) higher testosterone, 28.5% (5.3, 45.9)/24.1% (5.6, 38.9) lower SHBG levels, and 64.6% (19.4, 127.1)/42.5% (11.1, 82.9) higher FAI than controls after adjusting for age and recruitment cohort, maternal BMI, smoking, and pregnancy disorders, parental education, history of hypertension, diabetes, myocardial infarction or stroke, and subject's birth weight s.d. Odds ratios for having PCOS were 1.67 (0.44, 6.23)/3.11 (1.26, 7.70). CONCLUSIONS Women born preterm have a more hyperandrogenic hormonal profile, and those born LPT are approximately three times more likely at risk to have PCOS compared to women born at term.
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Affiliation(s)
- Marika Paalanne
- Finnish Institute for Health and Welfare, Population Health Unit, Oulu and Helsinki, Finland
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics, and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
- Correspondence should be addressed to M Paalanne;
| | - Marja Vääräsmäki
- Finnish Institute for Health and Welfare, Population Health Unit, Oulu and Helsinki, Finland
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics, and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Sanna Mustaniemi
- Finnish Institute for Health and Welfare, Population Health Unit, Oulu and Helsinki, Finland
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics, and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Marjaana Tikanmäki
- Finnish Institute for Health and Welfare, Population Health Unit, Oulu and Helsinki, Finland
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics, and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Karoliina Wehkalampi
- Finnish Institute for Health and Welfare, Population Health Unit, Oulu and Helsinki, Finland
- Children’s Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hanna-Maria Matinolli
- Finnish Institute for Health and Welfare, Population Health Unit, Oulu and Helsinki, Finland
- Research Center for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Research Flagship, University of Turku, Turku, Finland
| | - Johan Eriksson
- Finnish Institute for Health and Welfare, Population Health Unit, Oulu and Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Obstetrics and Gynecology, National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore
| | | | - Laure Morin-Papunen
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics, and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Eero Kajantie
- Finnish Institute for Health and Welfare, Population Health Unit, Oulu and Helsinki, Finland
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics, and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
- Children’s Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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17
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Obesity-associated cardiovascular risk in women: hypertension and heart failure. Clin Sci (Lond) 2021; 135:1523-1544. [PMID: 34160010 DOI: 10.1042/cs20210384] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/14/2021] [Accepted: 06/07/2021] [Indexed: 02/07/2023]
Abstract
The pathogenesis of obesity-associated cardiovascular diseases begins long prior to the presentation of a cardiovascular event. In both men and women, cardiovascular events, and their associated hospitalizations and mortality, are often clinically predisposed by the presentation of a chronic cardiovascular risk factor. Obesity increases the risk of cardiovascular diseases in both sexes, however, the clinical prevalence of obesity, as well as its contribution to crucial cardiovascular risk factors is dependent on sex. The mechanisms via which obesity leads to cardiovascular risk is also discrepant in women between their premenopausal, pregnancy and postmenopausal phases of life. Emerging data indicate that at all reproductive statuses and ages, the presentation of a cardiovascular event in obese women is strongly associated with hypertension and its subsequent chronic risk factor, heart failure with preserved ejection fraction (HFpEF). In addition, emerging evidence indicates that obesity increases the risk of both hypertension and heart failure in pregnancy. This review will summarize clinical and experimental data on the female-specific prevalence and mechanisms of hypertension and heart failure in women across reproductive stages and highlight the particular risks in pregnancy as well as emerging data in a high-risk ethnicity in women of African ancestry (AA).
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Kajantie E, Johnson S, Heinonen K, Anderson PJ, Wolke D, Evensen KAI, Räikkönen K, Darlow BA, van der Pal S, Indredavik MS, Jaekel J, Hovi P, Morrison K, Verrips E, Doyle LW. Common Core Assessments in follow-up studies of adults born preterm-Recommendation of the Adults Born Preterm International Collaboration. Paediatr Perinat Epidemiol 2021; 35:371-387. [PMID: 32990377 DOI: 10.1111/ppe.12694] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 05/04/2020] [Accepted: 05/10/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Of all newborns, 1%-2% are born very preterm (VP; <32 weeks) or with very low birthweight (VLBW; ≤1500 g). Advances in prenatal and neonatal care have substantially improved their survival, and the first generations who have benefited from these advances are now entering middle age. While most lead healthy lives, on average these adults are characterised by a number of adversities. These include cardiometabolic risk factors, airway obstruction, less physical activity, poorer visual function, lower cognitive performance, and a behavioural phenotype that includes inattention and internalising and socially withdrawn behaviour that may affect life chances and quality of life. Outcomes in later adulthood are largely unknown, and identifying trajectories of risk or resilience is essential in developing targeted interventions. Joint analyses of data and maintenance of follow-up of cohorts entering adulthood are essential. Such analyses are ongoing within the Adults Born Preterm International Collaboration (APIC; www.apic-preterm.org). Joint analyses require data harmonisation, highlighting the importance of consistent assessment methodologies. OBJECTIVE To present an expert recommendation on Common Core Assessments to be used in follow-up assessments of adults born preterm. METHODS Principles of Common Core Assessments were discussed at APIC meetings. Experts for each specific outcome domain wrote the first draft on assessments pertaining to that outcome. These drafts were combined and reviewed by all authors. Consensus was reached by discussion at APIC meetings. RESULTS We present a recommendation by APIC experts on consistent measures to be used in adult follow-up assessments. CONCLUSIONS The recommendation encompasses both "core" measures which we recommend to use in all assessments of adults born preterm that include the particular outcome. This will allow comparability between time and location. The recommendation also lists optional measures, focusing on current gaps in knowledge. It includes sections on study design, cardiometabolic and related biomarkers, biological samples, life style, respiratory, ophthalmic, cognitive, mental health, personality, quality of life, sociodemographics, social relationships, and reproduction.
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Affiliation(s)
- Eero Kajantie
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki and Oulu, Finland.,PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Kati Heinonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Peter J Anderson
- Turner Institute for Brain & Mental Health, Monash University, Melbourne, Vic., Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Kari Anne I Evensen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway.,Unit for Physiotherapy Services, Trondheim Municipality, Trondheim, Norway
| | - Katri Räikkönen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Brian A Darlow
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Sylvia van der Pal
- Department of Child Health, The Netherlands Organization for Applied Scientific Research TNO, Leiden, The Netherlands
| | - Marit S Indredavik
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Julia Jaekel
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki and Oulu, Finland.,Department of Psychology, University of Warwick, Coventry, UK.,Department of Child and Family Studies, University of Tennessee Knoxville, Knoxville, TN, USA
| | - Petteri Hovi
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki and Oulu, Finland.,Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.,Department of Pediatrics, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Katherine Morrison
- Department of Pediatrics, Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada
| | - Erik Verrips
- Department of Child Health, The Netherlands Organization for Applied Scientific Research TNO, Leiden, The Netherlands
| | - Lex W Doyle
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Research Office, Departments of Obstetrics and Gynaecology and of Paediatrics, The Royal Women's Hospital, University of Melbourne, Melbourne, Vic., Australia
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19
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Caanen MR, Peters HE, van de Ven PM, Jüttner AMFM, Laven JSE, van Hooff MHA, Lambalk CB. Anti-Müllerian Hormone Levels in Adolescence in Relation to Long-term Follow-up for Presence of Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2021; 106:e1084-e1095. [PMID: 33351079 PMCID: PMC7947839 DOI: 10.1210/clinem/dgaa949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Indexed: 11/20/2022]
Abstract
CONTEXT Anti-Müllerian hormone (AMH) measured in adolescence as biomarker for prediction of adult polycystic ovary syndrome (PCOS) is doubtful but not substantiated. OBJECTIVE To investigate whether serum AMH levels and other PCOS-associated features in adolescence can predict the presence of PCOS in adulthood. DESIGN AND SETTING A long-term follow-up study based on a unique adolescent study on menstrual irregularities performed between 1990 and 1997. PARTICIPANTS AND INTERVENTIONS AMH was assayed in 271 adolescent girls. Data on PCOS features were combined with AMH levels. In 160 of the 271 (59%) participants, we collected information in adulthood about their menstrual cycle pattern and presence of PCOS (features) by questionnaire 2 decades after the initial study. RESULTS AMH was higher in adolescent girls with oligomenorrhea compared with girls with regular cycles, median (interquartile range): 4.6 (3.1-7.5) versus 2.6 (1.7-3.8) μg/L (P < 0.001). Women with PCOS in adulthood had a higher median adolescent AMH of 6.0 compared with 2.5 μg/L in the non-PCOS group (P < 0.001). AMH at adolescence showed an area under the receiver operating characteristic curve for PCOS in adulthood of 0.78. In adolescent girls with oligomenorrhea the proportion developing PCOS in adulthood was 22.5% (95% CI, 12.4-37.4) against 5.1% (95% CI, 2.1-12.0) in girls with a regular cycle (P = 0.005). Given adolescent oligomenorrhea, adding high AMH as factor to predict adult PCOS or adult oligomenorrhea was of no value. CONCLUSIONS Adolescent AMH either alone or adjuvant to adolescent oligomenorrhea does not contribute as prognostic marker for PCOS in adulthood. Therefore, we do not recommend routine its use in clinical practice.
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Affiliation(s)
- Mirte R Caanen
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit, HV Amsterdam, the Netherlands
- Correspondence: Mirte Caanen, Department of Obstetrics & Gynaecology, Amsterdam UMC, Vrije Universiteit, 1081 HV Amsterdam, the Netherlands. E-mail:
| | - Henrike E Peters
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit, HV Amsterdam, the Netherlands
| | - Peter M van de Ven
- Clinical Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit, HV Amsterdam, the Netherlands
| | - Anne M F M Jüttner
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit, HV Amsterdam, the Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, CA Rotterdam, The Netherlands
| | - Marcel H A van Hooff
- Department of Obstetrics and Gynaecology, Sint Franciscus Hospital, PM Rotterdam, The Netherlands
| | - Cornelis B Lambalk
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit, HV Amsterdam, the Netherlands
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20
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Rantakallio JSS, Nevalainen JE, West SI, Ollila MM, Puukka K, Bloigu AH, Järvelin MR, Tapanainen JS, Franks S, Dunkel L, Piltonen TT, Vääräsmäki MS, Morin-Papunen LC. Association of Self-Reported Polycystic Ovary Syndrome, Obesity, and Weight Gain From Adolescence to Adulthood With Hypertensive Disorders of Pregnancy: A Community-Based Approach. Hypertension 2021; 77:1010-1019. [PMID: 33517680 DOI: 10.1161/hypertensionaha.120.15702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The purpose of this prospective, population-based cohort study was to evaluate the roles of polycystic ovary syndrome (PCOS), obesity, weight gain, and hyperandrogenemia in the development of hypertensive disorders of pregnancy (HDP) through fertile age both in PCOS and in non-PCOS women. The study population-NFBC1966 (Northern Finland Birth Cohort 1966)-allowed a long-term follow-up of women from age 14 until 46 years who developed HDP (n=408) or did not (n=3373). HDP diagnosis was confirmed by combining hospital discharge records, data from Finnish Medical Birth Registers, and the questionnaire data at age 46. Women with self-reported PCOS (srPCOS; n=279), defined by both oligo-amenorrhea and hirsutism at age 31 or with PCOS diagnosis by age 46, were compared with women without reported PCOS (n=1577). Women with srPCOS had an increased HDP risk (odds ratio, 1.56 [95% CI, 1.03-2.37]), but the association disappeared after adjustment for body mass index. In women with srPCOS and HDP, body mass index increased from age 14 to 46 significantly more than in srPCOS women without HDP (median [interquartile range], 9.82 [6.23-14.6] and 7.21 [4.16-10.5] kg/m2, respectively; P<0.001). Also, in non-PCOS women, the increase was higher in women with (7.54 [5.32-11.62] kg/m2; P<0.001) than without HDP (6.33 [3.90-9.33] kg/m2; P<0.001). Increase in waist circumference between ages 31 and 46 years was associated with HDP but not with PCOS. Hyperandrogenemia at 31 or 46 years did not associate with HDP (1.44 [0.98-2.11]). In conclusion, obesity, especially abdominal obesity, and weight gain from adolescence to age 46, but not srPCOS or hyperandrogenemia, were associated with an increased risk of HDP.
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Affiliation(s)
- Juhani S S Rantakallio
- From the Department of Obstetrics and Gynecology, PEDEGO Research Unit (J.S.S.R., J.E.N., S.I.W., M.-M.E.O., A.H.B., J.S.T., T.T.P., M.S.V., L.C.M.-P.), Medical Research Center, Oulu University Hospital, University of Oulu, Finland
| | - Jaana E Nevalainen
- From the Department of Obstetrics and Gynecology, PEDEGO Research Unit (J.S.S.R., J.E.N., S.I.W., M.-M.E.O., A.H.B., J.S.T., T.T.P., M.S.V., L.C.M.-P.), Medical Research Center, Oulu University Hospital, University of Oulu, Finland
| | - Sammeli I West
- From the Department of Obstetrics and Gynecology, PEDEGO Research Unit (J.S.S.R., J.E.N., S.I.W., M.-M.E.O., A.H.B., J.S.T., T.T.P., M.S.V., L.C.M.-P.), Medical Research Center, Oulu University Hospital, University of Oulu, Finland
| | - Meri-Maija Ollila
- From the Department of Obstetrics and Gynecology, PEDEGO Research Unit (J.S.S.R., J.E.N., S.I.W., M.-M.E.O., A.H.B., J.S.T., T.T.P., M.S.V., L.C.M.-P.), Medical Research Center, Oulu University Hospital, University of Oulu, Finland
| | - Katri Puukka
- NordLab Oulu, Department of Clinical Chemistry (K.P.), Medical Research Center, Oulu University Hospital, University of Oulu, Finland
| | - Aini H Bloigu
- From the Department of Obstetrics and Gynecology, PEDEGO Research Unit (J.S.S.R., J.E.N., S.I.W., M.-M.E.O., A.H.B., J.S.T., T.T.P., M.S.V., L.C.M.-P.), Medical Research Center, Oulu University Hospital, University of Oulu, Finland
| | - Marjo-Riitta Järvelin
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health (M.-R.J.), Imperial College London, United Kingdom
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Finland (M.-R.J.)
| | - Juha S Tapanainen
- From the Department of Obstetrics and Gynecology, PEDEGO Research Unit (J.S.S.R., J.E.N., S.I.W., M.-M.E.O., A.H.B., J.S.T., T.T.P., M.S.V., L.C.M.-P.), Medical Research Center, Oulu University Hospital, University of Oulu, Finland
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Finland (J.S.T.)
| | - Stephen Franks
- Institute of Reproductive and Developmental Biology (S.F.), Imperial College London, United Kingdom
| | - Leo Dunkel
- Centre for Endocrinology, William Harvey Research Institute, Barts and The London Medical School, United Kingdom (L.D.)
| | | | - Marja S Vääräsmäki
- From the Department of Obstetrics and Gynecology, PEDEGO Research Unit (J.S.S.R., J.E.N., S.I.W., M.-M.E.O., A.H.B., J.S.T., T.T.P., M.S.V., L.C.M.-P.), Medical Research Center, Oulu University Hospital, University of Oulu, Finland
| | - Laure C Morin-Papunen
- From the Department of Obstetrics and Gynecology, PEDEGO Research Unit (J.S.S.R., J.E.N., S.I.W., M.-M.E.O., A.H.B., J.S.T., T.T.P., M.S.V., L.C.M.-P.), Medical Research Center, Oulu University Hospital, University of Oulu, Finland
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21
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Chan JL, Pall M, Ezeh U, Mathur R, Pisarska MD, Azziz R. Screening for Androgen Excess in Women: Accuracy of Self-Reported Excess Body Hair Growth and Menstrual Dysfunction. J Clin Endocrinol Metab 2020; 105:5842110. [PMID: 32442282 PMCID: PMC7448931 DOI: 10.1210/clinem/dgz264] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 05/15/2020] [Indexed: 12/25/2022]
Abstract
CONTEXT Epidemiologic studies of polycystic ovary syndrome (PCOS) are limited, especially in populations where diagnostic resources are less available. In these settings, an accurate, low-cost screening tool would be invaluable. OBJECTIVE To test the use of a simple questionnaire to identify women at increased risk for PCOS and androgen excess (AE) disorders. STUDY DESIGN Prospective cohort study from 2006-2010. SETTING Community-based. PARTICIPANTS Women aged 14 to 45 years. INTERVENTION A screening telephone questionnaire consisting of 3 questions was tested, where participants were asked to self-assess the presence/absence of male-like hair and menstrual irregularity. Participants were then invited to undergo a direct examination, including completing a medical history and undergoing a modified Ferriman-Gallwey (mFG) hirsutism score, ovarian ultrasound, and measurement of circulating total and free testosterone, DHEAS, TSH, prolactin and 17-hydroxyprogesterone levels. MAIN OUTCOME MEASURE Accuracy of questionnaire in predicting PCOS, AE, and irregular menses. RESULTS Participants with self-assessed irregular menses and/or excess hair were labeled "Possible Androgen Excess (Poss-AE)" and those self-assessed with regular menses and no excess hair were labeled "Probable Non-Androgen Excess (Non-AE)." The study was completed in 206/298 (69%) of the Poss-AE and in 139/192 (73%) of the Non-AE. Of Poss-AE and Non-AE subjects, 82.5% and 15.8%, respextively, presented with PCOS. The calculated sensitivity, specificity, positive predictive value, and negative predictive value of the 3-question telephone survey to predict PCOS was 89%, 78%, 85%, and 83%, respectively. CONCLUSIONS A simple telephone questionnaire, based on self-assessment of body hair and menstrual status, can be used with a high predictive value to identify women at risk for AE disorders, including PCOS, and to detect healthy controls. This approach could be an important tool for needed epidemiologic studies.
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Affiliation(s)
- Jessica L Chan
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Marita Pall
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Uche Ezeh
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ruchi Mathur
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Margareta D Pisarska
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Obstetrics, The David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
- Department of Gynecology, The David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Ricardo Azziz
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Obstetrics, The David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
- Department of Gynecology, The David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
- Department of Health Policy, Management & Behavior, School of Public Health, University at Albany, State University of New York, Albany, New York
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
- Correspondence: Ricardo Azziz, 1209 Montgomery Hwy., Birmingham, AL 35216, USA. E-mail:
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22
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Obesity and hormonal contraception: an overview and a clinician's practical guide. Eat Weight Disord 2020; 25:1129-1140. [PMID: 31515745 DOI: 10.1007/s40519-019-00774-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/31/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The growing prevalence of obesity among the fertile female population poses a considerable problem to contraceptive providers. Obese women, who are more at risk for venous thromboembolism and cardiovascular events due to their condition, might be at an even higher risk of developing thromboembolic events when on medical contraception. Combined hormonal contraceptives might be less effective in obese women and may lead to unacceptable metabolic side effects for this population. In addition, the lack of safety data for weight loss drugs and the higher risk for complications during and after pregnancy require a close surveillance of the fertility status of obese patients. OBJECTIVE The aim of this narrative review is to summarize the available medical contraceptive options and to give the readers a practical guidance for a wise contraceptive choice with regards to obesity. METHODS A general literature review of peer-reviewed publications on the topic "obesity and contraception" was performed using the PubMed database. RESULTS Nowadays, there are many useful tools that help clinicians in choosing among the wide range of therapeutic possibilities, such as the World Health Organization (WHO) Medical Eligibility Criteria for contraceptive use. Furthermore, the great diversity of hormonal contraceptive formulations (combined hormonal formulations; progestin-only methods) and active substances (different estrogens and progestins) allow physicians to tailor therapies to patients' clinical peculiarities. CONCLUSION Long-acting reversible contraceptives [progestin-only implants, levonorgestrel-intra-uterine devices (IUDs) and copper IUDs] and progestin-only methods in general are excellent options for many categories of patients, including obese ones. LEVEL OF EVIDENCE V, narrative review.
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23
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Is there any association between age at menarche and anthropometric indices? A 15-year follow-up population-based cohort study. Eur J Pediatr 2020; 179:1379-1388. [PMID: 32146570 DOI: 10.1007/s00431-020-03575-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/04/2020] [Accepted: 01/10/2020] [Indexed: 01/07/2023]
Abstract
Anthropometric indices (AI) have been known to be associated with age at menarche (AAM). The aim of this longitudinal study was to evaluate the changes in AI and its association with AAM in a community-based population in Iran. From among 10,192 women, we included 6818, aged ≥ 10 years, who were post-menarche at the time of entering the study and their AAM ranged between 8 and 18 years. Study subjects were divided into groups by tertiles birth cohort (BC) (born ≤ 1939, 1940-1969, and ≥ 1970) and AAM (≤ 11, 12-15, and ≥ 16 years). Generalized estimating equation analysis was performed to evaluate the association between changes of AI in different BCs with AAM groups. Overall mean of AAM was 13.5 ± 1.4 years. Mean body mass index (BMI) was significantly increased over time more in those with early AAM (≤ 11 years) compared to those with AAM ≥ 16 years; changes in mean BMI of 1.24 kg/m2 (95% CI 0.32, 2.15), 2.61 kg/m2 (95% CI 1.90, 3.33), and 3.99 kg/m2 (95% CI 2.46, 5.51) in BC ≥ 1970, BC (1940-1969), and, BC ≤ 1939, respectively.Conclusion: Our findings showed an inverse association of AAM with mean BMI, waist to height ratio, and waist circumference, an association weaker in younger women compared to other age groups. What is Known: • Limited data are available on the association of menarcheal age with anthropometric indices. • Previous studies reported conflicting and inclusive results of this association. What is New: • Our results can provide beneficial information on the association of menarcheal age with anthropometric indices based on different age groups. • This long follow-up study shows an association of menarcheal age with anthropometric indices which are stronger in older women except for height.
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24
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Moubasher AEA, Abdel Basset HA, Khalil AAM, Youssef EMK. Levonorgestrel vs combined oral contraceptive pills in treatment of female acne and hirsutism. Dermatol Ther 2020; 33:e13700. [PMID: 32713062 DOI: 10.1111/dth.13700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 04/25/2020] [Accepted: 05/16/2020] [Indexed: 12/01/2022]
Abstract
Combined oral contraception was used in many studies for treatment of acne and hirsutism. However, levonorgestrel (LNG) alone has not been evaluated before. Our objective is to evaluate the efficacy of oral contraceptive (OC) pills containing LNG and ethinyl estradiol (EE) compared with LNG only for the treatment of acne and hirsutism in a randomized, controlled prospective clinical trial. Eighty females (20 with acne, 20 with hirsutism, and 40 healthy females) received LNG + EE or LNG only for 6 months. Assessment of acne by global acne grading system (GAGS) and hirsutism by modified Ferriman-Gallwey scale (MFGS) grading system and serum free testosterone was measured before and 6 months after treatment. Serum free testosterone was significantly higher before treatment in acne and hirsutism patients compared to control group (P < .000). In acne patients, after 6 months of treatment with LNG/EE, serum free testosterone, and (GAGS), were significantly decreased compared to LNG only (P < .000). In hirsutism group, after 6 months of treatment with LNG/EE, serum free testosterone and (MFGS), were nonsignificantly decreased compared to LNG only. OCs containing either LNG/EE or LNG seem to be effective and safe treatment for acne and hirsutism.
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Affiliation(s)
- Alaa E A Moubasher
- Department of Dermatology, Venerology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hisham A Abdel Basset
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Eman M K Youssef
- Department of Dermatology, Venerology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Triebner K, Johannessen A, Svanes C, Leynaert B, Benediktsdóttir B, Demoly P, Dharmage SC, Franklin KA, Heinrich J, Holm M, Jarvis D, Lindberg E, Rovira JMM, Muniozguren Agirre N, Sánchez-Ramos JL, Schlünssen V, Skulstad SM, Hustad S, Rodriguez FJ, Gómez Real F. Describing the status of reproductive ageing simply and precisely: A reproductive ageing score based on three questions and validated with hormone levels. PLoS One 2020; 15:e0235478. [PMID: 32603379 PMCID: PMC7326235 DOI: 10.1371/journal.pone.0235478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/16/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Most women live to experience menopause and will spend 4-8 years transitioning from fertile age to full menstrual stop. Biologically, reproductive ageing is a continuous process, but by convention, it is defined categorically as pre-, peri- and postmenopause; categories that are sometimes supported by measurements of sex hormones in blood samples. We aimed to develop and validate a new tool, a reproductive ageing score (RAS), that could give a simple and yet precise description of the status of reproductive ageing, without hormone measurements, to be used by health professionals and researchers. METHODS Questionnaire data on age, menstrual regularity and menstrual frequency was provided by the large multicentre population-based RHINE cohort. A continuous reproductive ageing score was developed from these variables, using techniques of fuzzy mathematics, to generate a decimal number ranging from 0.00 (nonmenopausal) to 1.00 (postmenopausal). The RAS was then validated with sex hormone measurements (follicle stimulating hormone and 17β-estradiol) and interview-data provided by the large population-based ECRHS cohort, using receiver-operating characteristics (ROC). RESULTS The RAS, developed from questionnaire data of the RHINE cohort, defined with high precision and accuracy the menopausal status as confirmed by interview and hormone data in the ECRHS cohort. The area under the ROC curve was 0.91 (95% Confidence interval (CI): 0.90-0.93) to distinguish nonmenopausal women from peri- and postmenopausal women, and 0.85 (95% CI: 0.83-0.88) to distinguish postmenopausal women from nonmenopausal and perimenopausal women. CONCLUSIONS The RAS provides a useful and valid tool for describing the status of reproductive ageing accurately, on a continuous scale from 0.00 to 1.00, based on simple questions and without requiring blood sampling. The score allows for a more precise differentiation than the conventional categorisation in pre-, peri- and postmenopause. This is useful for epidemiological research and clinical trials.
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Affiliation(s)
- Kai Triebner
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Core Facility for Metabolomics, University of Bergen, Bergen, Norway
| | - Ane Johannessen
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Cecilie Svanes
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | | | | | - Pascal Demoly
- Department of Pulmonology—Division of Allergy, University Hospital of Montpellier, Montpellier, France
| | - Shyamali C. Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population Health, University of Melbourne, Melbourne, Australia
| | - Karl A. Franklin
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Joachim Heinrich
- Allergy and Lung Health Unit, Melbourne School of Population Health, University of Melbourne, Melbourne, Australia
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig Maximilians University Munich, Munich, Germany
| | - Mathias Holm
- Department of Occupational and Environmental Medicine, Göteborgs Universitet, Göteborg, Sweden
| | - Deborah Jarvis
- Department of Respiratory Epidemiology, Occupational Medicine and Public Health, Imperial College, London, England, United Kingdom
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | | | | | | | - Vivi Schlünssen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- National Research Center for the Working Environment, Copenhagen, Denmark
| | - Svein Magne Skulstad
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Steinar Hustad
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Core Facility for Metabolomics, University of Bergen, Bergen, Norway
| | | | - Francisco Gómez Real
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
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Jena SK, Mishra L, Naik SS, Khan S. Awareness and opinion about polycystic ovarian syndrome (PCOS) among young women: a developing country perspective. Int J Adolesc Med Health 2020; 33:123-126. [PMID: 32549137 DOI: 10.1515/ijamh-2018-0166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/02/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To explore the perception on PCOS and its prevalence among adolescent and young women. METHODS The study was conducted over 2 year period in a tertiary care teaching hospital from Eastern India. A pre-formed, validated questionnaire was used to record the details. Descriptive statistics was used to report the findings. RESULTS Of 965 young patients with mean (SD) age 20.64 (2.1) years, 27 (2.79 %) were aware of an entity called PCOS. Awareness among adolescents with PCOS was 25.9 % (7/27). All aware patients belonged to the urban sector with professionals constituting around 48%, of which 11% were students. The major source of information among aware patients was from doctors (40.7%), and friends and Internet (25.9%); rest being from books, newspapers, and teachers. Majority (70%) were aware that diet restriction and exercise were the primary modalities of treatment, whereas, only 3.7% knew about the role of contraceptive pills in PCOS. CONCLUSIONS Awareness regarding PCOS among the young women is very low mainly in the rural set up. Doctors and health staffs should play a major role in spreading awareness of the entity to prevent long term complications.
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Affiliation(s)
| | - Lipsa Mishra
- Department of Obstetrics and Gynecology, AIIMS, Bhubaneswar, India
| | | | - Shahnawaz Khan
- Department of Obstetrics and Gynecology, AIIMS, Bhubaneswar, India
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Karjula S, Morin-Papunen L, Franks S, Auvinen J, Järvelin MR, Tapanainen JS, Jokelainen J, Miettunen J, Piltonen TT. Population-based Data at Ages 31 and 46 Show Decreased HRQoL and Life Satisfaction in Women with PCOS Symptoms. J Clin Endocrinol Metab 2020; 105:5709653. [PMID: 31970392 PMCID: PMC7150615 DOI: 10.1210/clinem/dgz256] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 04/03/2020] [Indexed: 12/11/2022]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS) is associated with decreased health-related quality of life (HRQoL), but longitudinal data beyond the reproductive years are lacking, and the impact of isolated PCOS symptoms is unclear. OBJECTIVE To study generic HRQoL using the 15D questionnaire, life satisfaction, and self-reported health status in women with PCOS symptoms at ages 31 and 46 years. DESIGN A longitudinal assessment using the Northern Finland Birth Cohort 1966. SETTING General community. PARTICIPANTS The 15D data were available for women reporting isolated oligo-amenorrhea (OA; at age 31 years, 214; and 46 years, 211), isolated hirsutism (H; 31 years, 211; and 46 years, 216), OA + H (PCOS; 31 years, 74; and 46 years, 75), or no PCOS symptoms (controls; 31 years, 1382; and 46 years, 1412). Data for life satisfaction and current health status were available for OA (31 years, 329; and 46 years, 247), H (31 years, 323; and 46 years, 238), PCOS (31 years, 125; and 46 years, 86), control (31 years, 2182; and 46 years, 1613) groups. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) 15D HRQoL, questionnaires on life satisfaction, and self-reported health status. RESULTS HRQoL was lower at ages 31 and 46 in women with PCOS or H than in the controls. PCOS was an independent risk factor for low HRQoL, and the decrease in HRQoL in PCOS was similar to that of women with other chronic conditions, such as asthma, migraine, rheumatoid arthritis, and depression. The risk for low HRQoL in PCOS remained significant after adjusting for body mass index, hyperandrogenism, and socioeconomic status. Mental distress was the strongest contributing factor to HRQoL. PCOS was also associated with a risk for low life satisfaction and a 4-fold risk for reporting a poor health status. CONCLUSIONS Women with PCOS present with low HRQoL, decreased life satisfaction, and a poorer self-reported health status up to their late reproductive years. Assessments and interventions aiming to improve HRQoL in PCOS should be targeted beyond the fertile age.
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Affiliation(s)
- Salla Karjula
- Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Centre Oulu and PEDEGO Research Unit, Oulu, University Hospital of Oulu, University of Oulu, Oulu, Finland
| | - Laure Morin-Papunen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Centre Oulu and PEDEGO Research Unit, Oulu, University Hospital of Oulu, University of Oulu, Oulu, Finland
| | - Stephen Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Juha Auvinen
- Center for Life Course Health Research, Faculty of Medicine Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Marjo-Riitta Järvelin
- Department of Epidemiology and Biostatistics, Medical Research Council-PHE (Public Health England) Centre for Environment & Health, School of Public Health, Imperial College London, London, UK; Centre for Life Course Epidemiology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Juha S Tapanainen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Centre Oulu and PEDEGO Research Unit, Oulu, University Hospital of Oulu, University of Oulu, Oulu, Finland
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Jouko Miettunen
- Center for Life Course Health Research, Faculty of Medicine Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Terhi T Piltonen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Centre Oulu and PEDEGO Research Unit, Oulu, University Hospital of Oulu, University of Oulu, Oulu, Finland
- Correspondence and Reprint Requests: Terhi Piltonen, Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, PL 23 90029 OYS, Oulu, Finland. E-mail:
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West S, Ollila M, Franks S, Piltonen T, Jokelainen J, Nevalainen J, Puukka K, Ruokonen A, Järvelin M, Auvinen J, Tapanainen JS, Morin‐Papunen L. Overweight, obesity and hyperandrogenemia are associated with gestational diabetes mellitus: A follow‐up cohort study. Acta Obstet Gynecol Scand 2020; 99:1311-1319. [DOI: 10.1111/aogs.13883] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Sammeli West
- Department of Obstetrics and Gynecology Medical Research Center Oulu and PEDEGO Research Unit (Research Unit for Pediatrics Dermatology, Clinical Genetics, Obstetrics and Gynecology University Hospital of OuluUniversity of Oulu Oulu Finland
| | - Meri‐Maija Ollila
- Department of Obstetrics and Gynecology Medical Research Center Oulu and PEDEGO Research Unit (Research Unit for Pediatrics Dermatology, Clinical Genetics, Obstetrics and Gynecology University Hospital of OuluUniversity of Oulu Oulu Finland
| | - Stephen Franks
- Institute of Reproductive and Developmental Biology Imperial College London London UK
| | - Terhi Piltonen
- Department of Obstetrics and Gynecology Medical Research Center Oulu and PEDEGO Research Unit (Research Unit for Pediatrics Dermatology, Clinical Genetics, Obstetrics and Gynecology University Hospital of OuluUniversity of Oulu Oulu Finland
| | - Jari Jokelainen
- Center for Life Course Health Research Faculty of Medicine University of Oulu Oulu Finland
- Unit of General Practice Oulu University Hospital Oulu Finland
| | - Jaana Nevalainen
- Department of Obstetrics and Gynecology Medical Research Center Oulu and PEDEGO Research Unit (Research Unit for Pediatrics Dermatology, Clinical Genetics, Obstetrics and Gynecology University Hospital of OuluUniversity of Oulu Oulu Finland
| | - Katri Puukka
- Department of Clinical Chemistry NordLab Oulu Oulu University HospitalUniversity of Oulu Oulu Finland
| | - Aimo Ruokonen
- Department of Clinical Chemistry NordLab Oulu Oulu University HospitalUniversity of Oulu Oulu Finland
| | - Marjo‐Riitta Järvelin
- Department of Children, Young People and Families National Institute for Health and Welfare Oulu Finland
- Department of Epidemiology and Biostatistics MRC Health Protection Agency (HPA) Center for Environment and Health School of Public HealthImperial College London London UK
| | - Juha Auvinen
- Center for Life Course Health Research Faculty of Medicine University of Oulu Oulu Finland
- Unit of General Practice Oulu University Hospital Oulu Finland
| | - Juha S. Tapanainen
- Department of Obstetrics and Gynecology Medical Research Center Oulu and PEDEGO Research Unit (Research Unit for Pediatrics Dermatology, Clinical Genetics, Obstetrics and Gynecology University Hospital of OuluUniversity of Oulu Oulu Finland
- Department of Obstetrics and Gynecology University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Laure Morin‐Papunen
- Department of Obstetrics and Gynecology Medical Research Center Oulu and PEDEGO Research Unit (Research Unit for Pediatrics Dermatology, Clinical Genetics, Obstetrics and Gynecology University Hospital of OuluUniversity of Oulu Oulu Finland
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Meyer ML, Sotres‐Alvarez D, Steiner AZ, Cousins L, Talavera GA, Cai J, Daviglus ML, Loehr LR. Polycystic Ovary Syndrome Signs and Metabolic Syndrome in Premenopausal Hispanic/Latina Women: the HCHS/SOL Study. J Clin Endocrinol Metab 2020; 105:5698885. [PMID: 31917455 PMCID: PMC7007876 DOI: 10.1210/clinem/dgaa012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/08/2020] [Indexed: 12/12/2022]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS), a condition of androgen excess in women, is associated with cardiometabolic risk factors; however, this association is not fully characterized in a population-based sample of premenopausal women and high-risk groups such as Hispanics/Latinas. OBJECTIVE We examined the association of PCOS signs and metabolic syndrome (MetS) in premenopausal Hispanic/Latina women. METHODS This cross-sectional analysis includes 1427 women age 24 to 44 years from the Hispanic Community Health Study/Study of Latinos. PCOS signs included menstrual cycle greater than 35 days or irregular, self-reported PCOS, and oral contraceptive use to regulate periods or acne, and a composite of 1 or more PCOS signs. We calculated odds ratios (OR) and 95% CI for MetS, accounting for sociodemographic factors and the complex survey design; an additional model included body mass index (BMI). RESULTS The mean age was 34 years and 30% reported any PCOS sign. The odds of MetS were higher in women reporting cycles greater than 35 days or irregular (OR 1.63; CI: 1.07-2.49) vs cycles 24 to 35 days, self-reported PCOS (OR 2.49; CI: 1.38-4.50) vs no PCOS, and any PCOS sign (OR 1.58; CI: 1.10-2.26) vs none. We found no association between OC use to regulate periods or acne and MetS (OR 1.1; CI: 0.6-1.8). When adjusting for BMI, only the association of self-reported PCOS and MetS was attenuated (OR 1.78; CI: 0.92-3.44). CONCLUSIONS In Hispanic/Latina women, irregular menstrual cycles, self-reported PCOS, and any PCOS sign were associated with MetS and could indicate women at metabolic disease risk.
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Affiliation(s)
- Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
- Correspondence: Michelle L. Meyer, PhD, MPH, University of North Carolina Chapel Hill, Department of Emergency Medicine, 170 Manning Drive, Campus Box 7594, Chapel Hill, North Carolina 27599-7594. E-mail:
| | | | - Anne Z Steiner
- Department of Obstetrics and Gynecology, Duke University, Duke, North Carolina
| | - Larry Cousins
- Children’s Specialists of San Diego, San Diego, California
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, San Diego, California
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina-Chapel Hill, North Carolina
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois
| | - Laura R Loehr
- Division of General Medicine and Clinical Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
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Ollila MM, Kiviniemi A, Stener-Victorin E, Tulppo M, Puukka K, Tapanainen J, Franks S, Morin-Papunen L, Piltonen T. Effect of polycystic ovary syndrome on cardiac autonomic function at a late fertile age: a prospective Northern Finland Birth Cohort 1966 study. BMJ Open 2019; 9:e033780. [PMID: 31843853 PMCID: PMC6924836 DOI: 10.1136/bmjopen-2019-033780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Previous studies of women in their 20s and 30s have reported impaired autonomic function in women with polycystic ovary syndrome (PCOS). We aimed to study, for the first time, whether PCOS is associated with impaired cardiac autonomic function independent of metabolic and hormonal status in their late reproductive years. DESIGN A prospective Northern Finland Birth Cohort 1966 (NFBC1966) study including 5889 women born in 1966 and followed through the age of 46. At that age, n=3706/5123 women (72%) answered the postal questionnaires and n=3280/5123 women (64%) participated in the clinical examination. SETTING General community. PARTICIPANTS The sample included women presenting both irregular menses (oligomenorrhoea or amenorrhoea) and hirsutism at age 31 (n=125) or with formally diagnosed PCOS by age 46 (n=181) and women without PCOS symptoms or diagnosis (n=1577). PRIMARY AND SECONDARY OUTCOME MEASURES Heart rate variability parameters: the root mean square of successive R-R differences (rMSSD), spectral power densities (LF: low frequency and HF: high frequency) and baroreflex sensitivity (BRS). RESULTS We found that parasympathetic activity (assessed by rMSSD: 19.5 (12.4; 31.9) vs 24.3 (16.1; 34.8) ms, p=0.004 and HF: 172 (75; 399) vs 261 (112; 565) ms2, p=0.002) and BRS (6.13±3.12 vs 6.99±3.52 ms/mm Hg, p=0.036) were lower in women with PCOS compared with the controls. However, in the multivariate regression analysis, PCOS, body mass index and the free androgen index did not significantly associate with rMSSD, whereas blood pressure, insulin resistance and triglycerides did. CONCLUSIONS We report here for the first time that late reproductive-aged women with PCOS display impaired cardiac autonomic function manifested as decreased vagal activity. Metabolic status, rather than hyperandrogenaemia and PCOS per se, was the strongest contributing factor. Given the link between cardiac morbidity and impaired autonomic function, the findings underline the importance of screening and treating metabolic abnormalities early on in women with PCOS.
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Affiliation(s)
- Meri-Maija Ollila
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
| | - Antti Kiviniemi
- Research Unit of Internal Medicine, Medical Research Centre Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | | | - Mikko Tulppo
- Research Unit of Internal Medicine, Medical Research Centre Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Katri Puukka
- NordLab Oulu, Department of Clinical Chemistry, University of Oulu and Oulu University Hospital, Medical Research Centre Oulu, Oulu, Finland
| | - Juha Tapanainen
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Stephen Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Laure Morin-Papunen
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
| | - Terhi Piltonen
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Centre, PEDEGO Research Unit, Oulu, Finland
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Lumme J, Sebert S, Pesonen P, Piltonen T, Järvelin MR, Herzig KH, Auvinen J, Ojaniemi M, Niinimäki M. Vitamin D Levels in Women with Polycystic Ovary Syndrome: A Population-Based Study. Nutrients 2019; 11:nu11112831. [PMID: 31752304 PMCID: PMC6893754 DOI: 10.3390/nu11112831] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/08/2019] [Accepted: 11/15/2019] [Indexed: 12/22/2022] Open
Abstract
Background: Conflicting evidence supports a role for vitamin D in women with reproductive disorders such as polycystic ovary syndrome (PCOS) but studies on large, unselected populations have been lacking. Methods: We conducted a general population-based study from the prospective Northern Finland Birth Cohort 1966 (NFBC1966). Serum 25-hydroksyvitamin D (25(OH)D) levels were evaluated in women with self-reported PCOS (n = 280) versus non-symptomatic controls (n = 1573) at the age of 31 with wide range of endocrine and metabolic confounders. Results: The levels of 25(OH)D were similar among women with and without self-reported PCOS (50.35 vs. 48.30 nmol/L, p = 0.051). Women with self-reported PCOS presented with a higher body mass index (BMI), increased insulin resistance, and low-grade inflammation and testosterone levels compared to controls. The adjusted linear regression model showed a positive association between total 25(OH)D levels in self-reported PCOS (β = 2.46, 95% confidence interval (CI) 0.84 to 4.08, p = 0.003). The result remained after adjustment for BMI, testosterone, homeostatic model assessment of insulin resistance (HOMA-IR), and high-sensitivity C-reactive protein (hs-CRP) levels. Conclusion: In this population-based setting, PCOS was associated with higher vitamin D levels when adjusting for confounding factors, without distinct beneficial effects on metabolic derangements.
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Affiliation(s)
- Johanna Lumme
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), University of Oulu, 90014 Oulu, Finland; (T.P.); (M.O.); (M.N.)
- Medical Research Center Oulu (MRC Oulu), University of Oulu, 90014 Oulu, Finland;
- Department of Obstetrics and Gynecology, Oulu University Hospital, 90220 Oulu, Finland
- Department of Pediatrics and Adolescence, Oulu University Hospital, 90220 Oulu, Finland
- Correspondence:
| | - Sylvain Sebert
- Center for Life-Course Health Research, Faculty of Medicine, University of Oulu, 90014 Oulu, Finland; (S.S.); (M.-R.J.); (J.A.)
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, 90014 Oulu, Finland;
- Biocenter Oulu, University of Oulu, 90014 Oulu, Finland
- Department of Epidemiology and Biostatistics, MRC Centre for Environment and Health, School of Public Health, Imperial College, London W2 1PG, UK
| | - Paula Pesonen
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, 90014 Oulu, Finland;
| | - Terhi Piltonen
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), University of Oulu, 90014 Oulu, Finland; (T.P.); (M.O.); (M.N.)
- Medical Research Center Oulu (MRC Oulu), University of Oulu, 90014 Oulu, Finland;
- Department of Obstetrics and Gynecology, Oulu University Hospital, 90220 Oulu, Finland
| | - Marjo-Riitta Järvelin
- Center for Life-Course Health Research, Faculty of Medicine, University of Oulu, 90014 Oulu, Finland; (S.S.); (M.-R.J.); (J.A.)
- Biocenter Oulu, University of Oulu, 90014 Oulu, Finland
- Department of Epidemiology and Biostatistics, MRC Centre for Environment and Health, School of Public Health, Imperial College, London W2 1PG, UK
- Department of Life Sciences, College of Health and Life Sciences, Brunel University London, Kingston Lane, Uxbridge, Middlesex UB8 3PH, UK
| | - Karl-Heinz Herzig
- Medical Research Center Oulu (MRC Oulu), University of Oulu, 90014 Oulu, Finland;
- Biocenter Oulu, University of Oulu, 90014 Oulu, Finland
- Institute of Biomedicine, University of Oulu, 90014 Oulu, Finland
- Department of Gastroenterology and Metabolism, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Juha Auvinen
- Center for Life-Course Health Research, Faculty of Medicine, University of Oulu, 90014 Oulu, Finland; (S.S.); (M.-R.J.); (J.A.)
- Oulunkaari Health Center, 91100 Ii, Finland
| | - Marja Ojaniemi
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), University of Oulu, 90014 Oulu, Finland; (T.P.); (M.O.); (M.N.)
- Medical Research Center Oulu (MRC Oulu), University of Oulu, 90014 Oulu, Finland;
- Department of Pediatrics and Adolescence, Oulu University Hospital, 90220 Oulu, Finland
| | - Maarit Niinimäki
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), University of Oulu, 90014 Oulu, Finland; (T.P.); (M.O.); (M.N.)
- Medical Research Center Oulu (MRC Oulu), University of Oulu, 90014 Oulu, Finland;
- Department of Obstetrics and Gynecology, Oulu University Hospital, 90220 Oulu, Finland
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Stanikova D, Zsido RG, Luck T, Pabst A, Enzenbach C, Bae YJ, Thiery J, Ceglarek U, Engel C, Wirkner K, Stanik J, Kratzsch J, Villringer A, Riedel-Heller SG, Sacher J. Testosterone imbalance may link depression and increased body weight in premenopausal women. Transl Psychiatry 2019; 9:160. [PMID: 31175272 PMCID: PMC6555814 DOI: 10.1038/s41398-019-0487-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/23/2019] [Accepted: 04/02/2019] [Indexed: 01/16/2023] Open
Abstract
Accumulating evidence supports a link between depression and being overweight in women. Given previously reported sex differences in fat accumulation and depression prevalence, as well as the likely role of sex hormones in both overweight and mood disorders, we hypothesised that the depression-overweight association may be mediated by sex hormones. To this end, we investigated the association of being overweight with depression, and then considered the role of sex hormones in relation to being overweight and depression in a large population-based cohort. We included a total of 3124 women, 970 premenopausal and 2154 postmenopausal from the LIFE-Adult cohort study in our analyses. We evaluated associations between being overweight (BMI >25 kg/m2), sex hormone levels, and depressive symptomatology according to Centre for Epidemiologic Studies Depression (CES-D) scores, and explored mediation of depression in a mediation model. Being overweight was significantly associated with depressive symptoms in premenopausal but not postmenopausal women. Both premenopausal and postmenopausal overweight women had higher free testosterone levels compared with normal weight women. Premenopausal women with depressive symptomatology had higher free testosterone levels compared to women without. We found a significant mediation effect of depressive symptomatology in overweight premenopausal women through free testosterone level. These findings highlight the association between being overweight and depressed, and suggest that high free testosterone levels may play a significant role in depression of overweight premenopausal women. Based on this, pharmacological approaches targeting androgen levels in overweight depressed females, in particular when standard anti-depressive treatments fail, could be of specific clinical relevance.
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Affiliation(s)
- Daniela Stanikova
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany. .,DIABGENE Laboratory, Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia. .,Department of Pediatrics, Medical Faculty at the Comenius University, Bratislava, Slovakia.
| | - Rachel G. Zsido
- 0000 0001 0041 5028grid.419524.fDepartment of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany ,0000 0001 0041 5028grid.419524.fEmotion & NeuroimaGinG (EGG) Lab, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Tobias Luck
- Department of Economic and Social Sciences & Institute of Social Medicine, Rehabilitation Sciences and Healthcare Research (ISRV), University of Applied Sciences Nordhausen, Nordhausen, Germany ,0000 0001 2230 9752grid.9647.cLIFE-Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Alexander Pabst
- 0000 0001 2230 9752grid.9647.cInstitute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Cornelia Enzenbach
- 0000 0001 2230 9752grid.9647.cLIFE-Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany ,0000 0001 2230 9752grid.9647.cInstitute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Yoon Ju Bae
- 0000 0001 2230 9752grid.9647.cInstitute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Joachim Thiery
- 0000 0001 2230 9752grid.9647.cLIFE-Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany ,0000 0001 2230 9752grid.9647.cInstitute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Uta Ceglarek
- 0000 0001 2230 9752grid.9647.cLIFE-Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany ,0000 0001 2230 9752grid.9647.cInstitute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Christoph Engel
- 0000 0001 2230 9752grid.9647.cLIFE-Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany ,0000 0001 2230 9752grid.9647.cInstitute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Kerstin Wirkner
- 0000 0001 2230 9752grid.9647.cLIFE-Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Juraj Stanik
- 0000 0001 2180 9405grid.419303.cDIABGENE Laboratory, Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia ,0000000109409708grid.7634.6Department of Pediatrics, Medical Faculty at the Comenius University, Bratislava, Slovakia ,0000 0001 2230 9752grid.9647.cCenter for Pediatric Research Leipzig, University Hospital for Children & Adolescents, University of Leipzig, Leipzig, Germany
| | - Juergen Kratzsch
- 0000 0001 2230 9752grid.9647.cInstitute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Arno Villringer
- 0000 0001 0041 5028grid.419524.fDepartment of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany ,0000 0001 0041 5028grid.419524.fEmotion & NeuroimaGinG (EGG) Lab, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany ,0000 0001 2230 9752grid.9647.cClinic of Cognitive Neurology, University of Leipzig, Leipzig, Germany
| | - Steffi G. Riedel-Heller
- 0000 0001 2230 9752grid.9647.cInstitute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Julia Sacher
- 0000 0001 0041 5028grid.419524.fDepartment of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany ,0000 0001 0041 5028grid.419524.fEmotion & NeuroimaGinG (EGG) Lab, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany ,0000 0001 2230 9752grid.9647.cClinic of Cognitive Neurology, University of Leipzig, Leipzig, Germany
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Ollila MME, Kaikkonen K, Järvelin MR, Huikuri HV, Tapanainen JS, Franks S, Piltonen TT, Morin-Papunen L. Self-Reported Polycystic Ovary Syndrome Is Associated With Hypertension: A Northern Finland Birth Cohort 1966 Study. J Clin Endocrinol Metab 2019; 104:1221-1231. [PMID: 30445634 PMCID: PMC7296204 DOI: 10.1210/jc.2018-00570] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 11/12/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS) is associated with many traditional cardiovascular disease risk factors, but it is unclear whether PCOS is an independent risk factor for hypertension. OBJECTIVE To investigate in a population-based setup whether PCOS associates with the risk of hypertension independently of body mass index (BMI) and with cardiovascular manifestations. DESIGN Cross-sectional assessments in the Northern Finland Birth Cohort 1966 at ages 31 and 46 years. SETTING General community. PARTICIPANTS Women who reported both oligo/amenorrhea and hirsutism at age 31 years and/or a diagnosis of PCOS by age 46 years [self-reported PCOS (srPCOS), n = 279] and women without PCOS symptoms or diagnosis (n = 1577). INTERVENTION None. MAIN OUTCOME MEASURES Blood pressure (BP), BMI, and cardiovascular manifestations. RESULTS Use of antihypertensive medication was significantly more common in women with srPCOS. At age 31 years, women with srPCOS had significantly higher systolic BP (SBP) and diastolic BP (DBP) than control women (SBP: normal weight: 119.9 ± 13.2 vs 116.9 ± 11.4 mm Hg, P = 0.017; overweight/obese: 126.1 ± 14.3 vs 123.0 ± 11.9 mm Hg, P = 0.031; and DBP: normal weight: 75.5 ± 10.0 vs 72.4 ± 9.6 mm Hg, P = 0.003; overweight/obese: 80.7 ± 11.8 vs 78.0 ± 10.6 mm Hg, P = 0.031). At age 46 years, srPCOS was significantly associated with hypertension (adjusted odds ratio = 1.56; 95% CI, 1.14 to 2.13) independently of BMI and with higher cardiovascular morbidity (6.8% vs 3.4%, P = 0.011). Hypertensive srPCOS displayed consistent, unfavorable changes in cardiac structure and function compared with controls. CONCLUSION Women with srPCOS displayed higher BP compared with controls already at early age and srPCOS was associated with hypertension independently of overweight/obesity. srPCOS was associated with increased cardiovascular morbidity in premenopausal women, suggesting that cardiovascular disease risk factors should be screened and efficiently managed early enough in women with PCOS.
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Affiliation(s)
- Meri-Maija E Ollila
- Department of Obstetrics and Gynecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
- Correspondence and Reprint Requests: Meri-Maija Ollila, MD, Department of Obstetrics and Gynecology, Oulu University Hospital, PL 23 90029 OYS, Finland. E-mail:
| | - Kari Kaikkonen
- Division of Cardiology, Department of Clinical Medicine, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Marjo-Riitta Järvelin
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
- Unit of Primary Health Care, Oulu University Hospital, OYS, Oulu, Finland
- Department of Life Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center, University Hospital of Oulu and University of Oulu, Oulu, Finland
| | - Juha S Tapanainen
- Department of Obstetrics and Gynecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Stephen Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom
| | - Terhi T Piltonen
- Department of Obstetrics and Gynecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
| | - Laure Morin-Papunen
- Department of Obstetrics and Gynecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
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Glueck CJ, Goldenberg N. Characteristics of obesity in polycystic ovary syndrome: Etiology, treatment, and genetics. Metabolism 2019; 92:108-120. [PMID: 30445140 DOI: 10.1016/j.metabol.2018.11.002] [Citation(s) in RCA: 184] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/22/2018] [Accepted: 11/05/2018] [Indexed: 01/01/2023]
Abstract
Polycystic ovary syndrome (PCOS) has multiple etiologies including ovarian and adrenal hyperandrogenism, neuro-endocrine and hypothalamic-pituitary dysfunction, and disorders of peripheral insulin resistance. Obesity is neither necessary nor sufficient for the PCOS phenotype, and the association of PCOS with obesity is not universal, with national, cultural, and ethnic differences. Obesity, particularly visceral adiposity which is common in obese and non-obese women with PCOS, amplifies and worsens all metabolic and reproductive outcomes in PCOS. Obesity increases insulin resistance and compensatory hyperinsulinemia, which in turn increases adipogenesis and decreases lipolysis. Obesity sensitizes thecal cells to LH stimulation and amplifies functional ovarian hyperandrogenism by upregulating ovarian androgen production. Obesity increases inflammatory adipokines which, in turn, increase insulin resistance and adipogenesis. Lifestyle interventions focused on diet-weight loss and concurrent exercise are central to therapy which also commonly subsequently needs to include pharmacologic therapy. PCOS symptoms commonly improve with 5% to 10% weight loss, but 25% to 50% weight loss, usually achievable only through bariatric surgery, may be required for morbid obesity unresponsive to lifestyle-medical treatment. Bariatric surgery is a valuable approach to weight loss in PCOS where BMI is ≥40 kg/m2 when non-surgical treatment and/or induction of pregnancy have failed, and can be an initial treatment when BMI is ≥50 kg/m2. Further research in PCOS is needed to better understand the fundamental basis of the disorder, to ameliorate obesity, to correct hyperandrogenism, ovulation, hyperinsulinemia, and to optimize metabolic homeostasis.
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Affiliation(s)
- Charles J Glueck
- The Cholesterol, Metabolism, and Thrombosis Research Center, 3906 Middleton Avenue, Cincinnati, OH 45220, United States of America.
| | - Naila Goldenberg
- The Cholesterol, Metabolism, and Thrombosis Research Center, 3906 Middleton Avenue, Cincinnati, OH 45220, United States of America
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Jacewicz-Święcka M, Kowalska I. Polycystic ovary syndrome and the risk of cardiometabolic complications in longitudinal studies. Diabetes Metab Res Rev 2018; 34:e3054. [PMID: 30089337 DOI: 10.1002/dmrr.3054] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 06/18/2018] [Accepted: 07/29/2018] [Indexed: 12/11/2022]
Abstract
The purpose of this study was to perform a review of the longitudinal studies to determine whether polycystic ovary syndrome is associated with higher prevalence of metabolic complications and cardiovascular morbidity and mortality. The primary outcomes included body mass index, metabolic syndrome and its components (waist circumference, lipid profile, arterial hypertension, abnormal glucose metabolism (impaired fasting glucose, impaired glucose tolerance, type 2 diabetes), insulin resistance, and cardiovascular diseases like stroke, angina, and coronary heart disease. Complications in pregnant women were beyond the scope of this review. PubMed database (1992-2018) was searched to identify proper publications. Finally, data from 47 articles were analysed. Studies differed in the design (prospective, retrospective, cohort, observational), research methods, polycystic ovary syndrome diagnostic criteria, studied populations, race, and ethnicity of the participants. Based on the data collected, it appears that women with polycystic ovary syndrome have higher prevalence of obesity, abdominal fat distribution, dyslipidaemia and deterioration of glucose metabolism, but increased prevalence of cardiovascular diseases is not proven.
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Affiliation(s)
- Małgorzata Jacewicz-Święcka
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Irina Kowalska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Bialystok, Bialystok, Poland
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Palm CVB, Glintborg D, Kyhl HB, McIntyre HD, Jensen RC, Jensen TK, Jensen DM, Andersen M. Polycystic ovary syndrome and hyperglycaemia in pregnancy. A narrative review and results from a prospective Danish cohort study. Diabetes Res Clin Pract 2018; 145:167-177. [PMID: 29689322 DOI: 10.1016/j.diabres.2018.04.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/17/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insulin resistance is common in polycystic ovary syndrome (PCOS). PCOS may be associated with increased risk of gestational diabetes mellitus (GDM). OBJECTIVES To (1) review literature regarding PCOS and hyperglycaemia in pregnancy and (2) present original data from Odense Child Cohort (OCC) regarding GDM in PCOS. METHODS Literature search including original studies from 2000-18. OCC included 2548 pregnant women, 9.5% (n = 241) had PCOS. Fasting plasma glucose was measured in 1519 and 659 oral glucose tolerance tests were performed (with risk factor for GDM, n = 384, without risk factors, n = 275), applying two different GDM criteria. RESULTS 30 studies were eligible using 12 different sets of diagnostic criteria for GDM. Ten studies included n > 50, control group, assessment of GDM and BMI. Results were not uniform, but supported that higher BMI, higher age, Asian ethnicity, and fertility treatment increased the risk of GDM in PCOS. In OCC, women with PCOS and controls had similar prevalences of GDM independent of different sets of criteria for GDM. CONCLUSION PCOS may not be an individual risk factor for GDM. Pregnancies in PCOS are characterized by factors known to increase risk of GDM, especially high BMI and fertility treatment.
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Affiliation(s)
- Camilla Viola Buskbjerg Palm
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark; Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Dorte Glintborg
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Henriette Boye Kyhl
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark; Odense Patient Data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - H David McIntyre
- Mater Research, University of Queensland, Brisbane, Australia; Danish Diabetes Academy, Odense University Hospital, Odense, Denmark
| | | | - Tina Kold Jensen
- Odense Patient Data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Dorte Møller Jensen
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark; Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Marianne Andersen
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark.
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Ongsupharn S, Pantasri T, Lattiwongsakorn W, Morakote N. The Association between Oligomenorrhea, Onset of Menopause and Metabolic Syndrome in Thai Postmenopausal Women. J Menopausal Med 2018; 24:100-107. [PMID: 30202759 PMCID: PMC6127020 DOI: 10.6118/jmm.2018.24.2.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/01/2018] [Accepted: 05/09/2018] [Indexed: 12/05/2022] Open
Abstract
Objectives This study explored the association between a history of oligomenorrhea and onset of menopause and metabolic parameters. Methods The study population was 605 postmenopausal women who were patients at the Menopause Clinic, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand between February 2015 and December 2015. A questionnaire was used to ask all women about their history of oligomenorrhea. The study also collected medical data, including weight, height, waist circumference, blood pressure, and blood glucose and lipid profile. Results Of the 231 postmenopausal women with a complete data record, 31 had a history of oligomenorrhea and 200 did not. The age of onset of menopause was around 48 years in both groups. Prevalence of metabolic syndrome was 12.1%. More women with a waist circumference larger than 80 cm had a history of oligomenorrhea at the interview than women who had not, but a history of oligomenorrhea did not relate to other metabolic parameters. The adjusted odds ratio of a history of oligomenorrhea to waist circumference was 3.69 (95% confidence interval, 1.17–11.64). Conclusions A history of oligomenorrhea did not affect the age at menopause, but was associated with waist circumference during menopause.
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Affiliation(s)
- Siripen Ongsupharn
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Tawiwan Pantasri
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Worashorn Lattiwongsakorn
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nuntana Morakote
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Mustaniemi S, Vääräsmäki M, Eriksson JG, Gissler M, Laivuori H, Ijäs H, Bloigu A, Kajantie E, Morin-Papunen L. Polycystic ovary syndrome and risk factors for gestational diabetes. Endocr Connect 2018; 7:859-869. [PMID: 29858213 PMCID: PMC6026881 DOI: 10.1530/ec-18-0076] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/31/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To study the roles of self-reported symptoms and/or prior diagnosis of polycystic ovary syndrome (PCOS) and other potential risk factors for gestational diabetes mellitus (GDM) and to clarify whether the screening of GDM in early pregnancy is beneficial for all women with PCOS. DESIGN The FinnGeDi multicentre case-control study including 1146 women with singleton pregnancies diagnosed with GDM and 1066 non-diabetic pregnant women. There were 174 women with PCOS (symptoms and/or diagnosis self-reported by a questionnaire) and 1767 women without PCOS (data missing for 271). METHODS The study population (N = 1941) was divided into four subgroups: GDM + PCOS (N = 105), GDM + non-PCOS (N = 909), non-GDM + PCOS (N = 69), and controls (N = 858). The participants' characteristics and their parents' medical histories were compared. RESULTS The prevalence of PCOS was 10.4% among GDM women and 7.4% among non-diabetics (odds ratios (OR) 1.44, 95% CI: 1.05-1.97), but PCOS was not an independent risk for GDM after adjustments for participants' age and pre-pregnancy BMI (OR 1.07, 95% CI: 0.74-1.54). In a multivariate logistic regression analysis, the most significant parameters associated with GDM were overweight, obesity, age ≥35 years, participant's mother's history of GDM, either parent's history of type 2 diabetes (T2D) and participant's own preterm birth. CONCLUSIONS The increased risk of GDM in women with PCOS was related to obesity and increased maternal age rather than to PCOS itself, suggesting that routine early screening of GDM in PCOS women without other risk factors should be reconsidered. Instead, family history of GDM/T2D and own preterm birth were independent risk factors for GDM.
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Affiliation(s)
- Sanna Mustaniemi
- Public Health Promotion UnitNational Institute for Health and Welfare, Helsinki, Finland
- PEDEGO Research UnitMRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Marja Vääräsmäki
- Public Health Promotion UnitNational Institute for Health and Welfare, Helsinki, Finland
- PEDEGO Research UnitMRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Johan G Eriksson
- Department of General Practice and Primary Health CareUniversity of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research CentreHelsinki, Finland
| | - Mika Gissler
- Information Services DepartmentNational Institute for Health and Welfare, Helsinki, Finland
- Division of Family MedicineDepartment of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Hannele Laivuori
- Medical and Clinical GeneticsUniversity of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Obstetrics and GynaecologyTampere University Hospital, Tampere, Finland
- Faculty of Medicine and Life SciencesUniversity of Tampere, Tampere, Finland
- Institute for Molecular Medicine FinlandHelsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Hilkka Ijäs
- Public Health Promotion UnitNational Institute for Health and Welfare, Helsinki, Finland
- PEDEGO Research UnitMRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Aini Bloigu
- PEDEGO Research UnitMRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Eero Kajantie
- Public Health Promotion UnitNational Institute for Health and Welfare, Helsinki, Finland
- PEDEGO Research UnitMRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Children's HospitalUniversity of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laure Morin-Papunen
- PEDEGO Research UnitMRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Gill D, Brewer CF, Del Greco M F, Sivakumaran P, Bowden J, Sheehan NA, Minelli C. Age at menarche and adult body mass index: a Mendelian randomization study. Int J Obes (Lond) 2018; 42:1574-1581. [PMID: 29549348 DOI: 10.1038/s41366-018-0048-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 11/13/2017] [Accepted: 01/22/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Pubertal timing has psychological and physical sequelae. While observational studies have demonstrated an association between age at menarche and adult body mass index (BMI), confounding makes it difficult to infer causality. METHODS The Mendelian randomization (MR) technique is not limited by traditional confounding and was used to investigate the presence of a causal effect of age at menarche on adult BMI. MR uses genetic variants as instruments under the assumption that they act on BMI only through age at menarche (no pleiotropy). Using a two-sample MR approach, heterogeneity between the MR estimates from individual instruments was used as a proxy for pleiotropy, with sensitivity analyses performed if detected. Genetic instruments and estimates of their association with age at menarche were obtained from a genome-wide association meta-analysis on 182,416 women. The genetic effects on adult BMI were estimated using data on 80,465 women from the UK Biobank. The presence of a causal effect of age at menarche on adult BMI was further investigated using data on 70,692 women from the GIANT Consortium. RESULTS There was evidence of pleiotropy among instruments. Using the UK Biobank data, after removing instruments associated with childhood BMI that were likely exerting pleiotropy, fixed-effect meta-analysis across instruments demonstrated that a 1 year increase in age at menarche reduces adult BMI by 0.38 kg/m2 (95% CI 0.25-0.51 kg/m2). However, evidence of pleiotropy remained. MR-Egger regression did not suggest directional bias, and similar estimates to the fixed-effect meta-analysis were obtained in sensitivity analyses when using a random-effect model, multivariable MR, MR-Egger regression, a weighted median estimator and a weighted mode-based estimator. The direction and significance of the causal effect were replicated using GIANT Consortium data. CONCLUSION MR provides evidence to support the hypothesis that earlier age at menarche causes higher adult BMI. Complex hormonal and psychological factors may be responsible.
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Affiliation(s)
- Dipender Gill
- Department of Clinical Pharmacology and Therapeutics, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Christopher F Brewer
- Faculty of Medicine, Imperial College London, Sir Alexander Fleming Building, London, UK
| | | | - Prasanthi Sivakumaran
- Faculty of Medicine, Imperial College London, Sir Alexander Fleming Building, London, UK
| | - Jack Bowden
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Nuala A Sheehan
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Cosetta Minelli
- Population Health and Occupational Disease, NHLI, Imperial College London, London, UK
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Lønnebotn M, Natvig GK, Benediktsdóttir B, Burgess JA, Holm M, Jógi R, Lindberg E, Macsali F, Schlünssen V, Skulstad SM, Franklin KA, Vanky E, Gòmez Real F. Polycystic ovary syndrome, body mass index and hypertensive disorders in pregnancy. Pregnancy Hypertens 2017. [PMID: 29523270 DOI: 10.1016/j.preghy.2017.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Some studies of women with polycystic ovary syndrome (PCOS) report increased prevalence of hypertensive disorders in pregnancy, while others do not. Several of these studies do not control for obesity. We aimed to study whether PCOS is associated with hypertensive disorders in pregnancy and whether it is dependent on body mass index (BMI). STUDY DESIGN We present a cross-sectional analysis of 3732 women from Denmark, Estonia, Iceland, Norway and Sweden, born in 1945-72, who participated in the Respiratory Health In Northern Europe (RHINE) study and answered an extensive women's health questionnaire on menstruation, PCOS, infertility, pregnancy history and childbirth. The main outcome measurement was hypertensive disorders of pregnancy. We adjusted for smoking, age, infertility treatment and study center. Effect modification by BMI was assessed. RESULTS PCOS was related to hypertensive disorders in pregnancy with a relative risk (RR) of 1.62 (95% CI 1.09-2.42). This relationship was found among underweight women with a BMI of <18.5 kg/m2 [RR = 5.2 (95% CI 1.66-16.5)] and obese women with a BMI of ≥30 kg/m2 [RR = 2.36 (95% CI 1.29-4.31)], but not among normal-weight women, BMI 18.5-25 kg/m2 [1.08 (0.53-2.20)], or overweight women, BMI 25-30 kg/m2 [1.24 (0.50-3.08)] (p-interaction = 0.041). CONCLUSION Polycystic ovary syndrome is associated with hypertensive disorders in pregnancy. This association only occurs among underweight and obese women and not among normal-weight and slightly overweight women.
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Affiliation(s)
- Marianne Lønnebotn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Gerd Karin Natvig
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - John A Burgess
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, University of Melbourne, Australia
| | - Mathias Holm
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Rain Jógi
- Lung Clinics, Tartu University Clinics, Tartu, Estonia
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Ferenc Macsali
- Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Vivi Schlünssen
- National Research Institute for the Working Environment, Copenhagen and Department of Public Health, Aarhus University, Denmark
| | - Svein Magne Skulstad
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Karl A Franklin
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Eszter Vanky
- Department of Obstetrics and Gynecology, St. Olav's Hospital, University Hospital of Trondheim, Norway; Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Francisco Gòmez Real
- Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Norway
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41
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Polycystic ovary syndrome, personality, and depression: A twin study. Psychoneuroendocrinology 2017; 85:63-68. [PMID: 28825976 DOI: 10.1016/j.psyneuen.2017.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 08/06/2017] [Accepted: 08/07/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Women with polycystic ovary syndrome (PCOS) are at elevated risk for suffering from depression. Neuroticism is a personality trait that has been associated with an increased risk for developing major depressive disorder (MDD). The aim of the present study was to quantify and decompose the correlation between neuroticism, PCOS, and MDD into shared and unique genetic and environmental etiologies, by using quantitative genetic methods. METHODS In a cohort of 12,628 Swedish female twins born from 1959 to 1985, neuroticism, PCOS identified by symptoms of hyperandrogenemia (i.e., hirsutism) and oligo- and/or anovulation, and lifetime MDD status were determined through questionnaire responses. Structural equation modeling was used to study the genetic and environmental sources of the variation within, and covariation between neuroticism, PCOS, and MDD. RESULTS Female twins with PCOS (n=752) had significantly higher levels of neuroticism than women without PCOS, and a 2-fold increase in odds for a lifetime prevalence of MDD. The phenotypic correlation between PCOS and MDD was 0.19, with 63% of the correlation attributable to common genetic factors between the two traits. When taking into account neuroticism, 41% was attributable to common genetic factors and 9% attributable to common environmental factors shared between all three traits, with the remainder attributable to components unique to PCOS and MDD. CONCLUSION There are common genetic factors between neuroticism, PCOS, and MDD; however, neuroticism shares approximately half of the genetic and environmental components behind the phenotypic correlation between PCOS and MDD, providing some etiological evidence behind the comorbidity between PCOS and depression.
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42
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Karjula S, Morin-Papunen L, Auvinen J, Ruokonen A, Puukka K, Franks S, Järvelin MR, Tapanainen JS, Jokelainen J, Miettunen J, Piltonen TT. Psychological Distress Is More Prevalent in Fertile Age and Premenopausal Women With PCOS Symptoms: 15-Year Follow-Up. J Clin Endocrinol Metab 2017; 102:1861-1869. [PMID: 28323926 PMCID: PMC5470769 DOI: 10.1210/jc.2016-3863] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/22/2017] [Indexed: 01/30/2023]
Abstract
Context Polycystic ovary syndrome (PCOS) is associated with increased psychological distress, obesity and hyperandrogenism being suggested as key promoters. Objectives To investigate the prevalence of anxiety/depression and their coexistence in women with PCOS/PCOS-related symptoms at ages 31 and 46. The roles of obesity, hyperandrogenism, and awareness of PCOS on psychological distress were also assessed. Design Population-based follow-up. Setting Northern Finland Birth Cohort 1966 with 15-year follow-up. Participants At age 31, a questionnaire-based screening for oligoamenorrhea (OA) and hirsutism (H): 2188 asymptomatic (controls), 331 OA, 323 H, and 125 OA plus H (PCOS). Follow-up at age 46: 1576 controls, 239 OA, 231 H, and 85 PCOS. Interventions Questionnaire-based screening for anxiety and depression symptoms (Hopkins Symptom Checklist-25) and previously diagnosed/treated depression at ages 31 and 46. Body mass index (BMI), serum testosterone/free androgen index, and awareness of polycystic ovaries/PCOS on psychological distress were also assessed. Main Outcomes Population-based prevalence of anxiety and/or depression in women with PCOS/PCOS-related symptoms at ages 31 and 46. Results Anxiety and/or depression symptoms, their coexistence, and rate of depression were increased at ages 31 and 46 in women with PCOS or isolated H compared with controls. High BMI or hyperandrogenism did not associate with increased anxiety or depression symptoms. The awareness of PCOS was associated with increased anxiety. Conclusions Women with PCOS or isolated H present more often with anxiety and/or depression symptoms and their coexistence compared with controls. High BMI or hyperandrogenism did not provoke psychological distress in PCOS. The awareness of PCOS increased anxiety but did not associate with severe anxiety or depression.
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Affiliation(s)
- Salla Karjula
- Department of Obstetrics and Gynecology, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- Medical Research Center, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- PEDEGO Research Unit, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
| | - Laure Morin-Papunen
- Department of Obstetrics and Gynecology, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- Medical Research Center, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- PEDEGO Research Unit, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
| | - Juha Auvinen
- Medical Research Center, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- Center for Life Course Health Research, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
| | - Aimo Ruokonen
- Medical Research Center, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- NordLab Oulu, Department of Clinical Chemistry, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
| | - Katri Puukka
- Medical Research Center, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- NordLab Oulu, Department of Clinical Chemistry, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
| | - Stephen Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, London W12 ONN, United Kingdom
| | - Marjo-Riitta Järvelin
- Center for Life Course Epidemiology, Faculty of Medicine, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- Department of Epidemiology and Biostatistics, Medical Research Council-Public Health England Centre for Environment and Health, School of Public Health, Imperial College London, London W2 1PG, United Kingdom
| | - Juha S. Tapanainen
- Department of Obstetrics and Gynecology, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- Medical Research Center, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- PEDEGO Research Unit, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, FI-00014 Helsinki, Finland
| | - Jari Jokelainen
- Faculty of Medicine, University of Oulu, FI-90014 Oulu, Finland
| | - Jouko Miettunen
- Medical Research Center, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- Center for Life Course Health Research, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
| | - Terhi T. Piltonen
- Department of Obstetrics and Gynecology, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- Medical Research Center, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
- PEDEGO Research Unit, University Hospital of Oulu, University of Oulu, FI-90014 Oulu, Finland
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Couto Alves A, Valcarcel B, Mäkinen VP, Morin-Papunen L, Sebert S, Kangas AJ, Soininen P, Das S, De Iorio M, Coin L, Ala-Korpela M, Järvelin MR, Franks S. Metabolic profiling of polycystic ovary syndrome reveals interactions with abdominal obesity. Int J Obes (Lond) 2017; 41:1331-1340. [PMID: 28546543 PMCID: PMC5578435 DOI: 10.1038/ijo.2017.126] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/21/2017] [Accepted: 03/26/2017] [Indexed: 01/03/2023]
Abstract
Background: Polycystic ovary syndrome (PCOS) is a common reproductive disorder associated with metabolic disturbances including obesity, insulin resistance and diabetes mellitus. Here we investigate whether changes in the metabolic profile of PCOS women are driven by increased tendency to obesity or are specific features of PCOS related to increased testosterone levels. Design and methods: We conducted an NMR metabolomics association study of PCOS cases (n=145) and controls (n=687) nested in a population-based birth cohort (n=3127). Subjects were 31 years old at examination. The main analyses were adjusted for waist circumference (WC) as a proxy measure of central obesity. Subsequently, metabolite concentrations were compared between cases and controls within pre-defined WC strata. In each stratum, additional metabolomics association analyses with testosterone levels were conducted separately among cases and controls. Results: Overall, women with PCOS showed more adverse metabolite profiles than the controls. Four lipid fractions in different subclasses of very low density lipoprotein (VLDL) were associated with PCOS, after adjusting for WC and correction for multiple testing (P<0.002). In stratified analysis the PCOS women within large WC strata (⩾98 cm) had significantly lower high density lipoprotein (HDL) levels, Apo A1 and albumin values compared with the controls. Testosterone levels were significantly associated with VLDL and serum lipids in PCOS cases with large WC but not in the controls. The higher testosterone levels, adjusted for WC, associated adversely with insulin levels and HOMA IR in cases but not in the controls. Conclusions: Our findings show that both abdominal obesity and hyperandrogenism contribute to the dyslipidaemia and other metabolic traits of PCOS which all may negatively contribute to the long-term health of women with PCOS.
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Affiliation(s)
- A Couto Alves
- Department of Epidemiology and Biostatistics, MRC Health Protection Agency (HPE) Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - B Valcarcel
- Rheumatology Unit, Institute of Child Health, University College London, London, UK
| | - V-P Mäkinen
- South Australian Health and Medical Research Center, Adelaide, Australia.,SAHMRI, School of Biological Sciences, University of Adelaide, Adelaide, Australia.,Computational Medicine, Center for Life-Course Health Research, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - L Morin-Papunen
- Department of Obstetrics and Gynecology, University Hospital of Oulu, Medical Research Center Oulu and PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - S Sebert
- Center for Life-Course Health Research, Northern Finland Cohort Center, Faculty of Medicine, University of Oulu, Oulu, Finland.,Biocenter Oulu, University of Oulu, Oulu, Finland
| | - A J Kangas
- Computational Medicine, Center for Life-Course Health Research, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - P Soininen
- SAHMRI, School of Biological Sciences, University of Adelaide, Adelaide, Australia.,NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - S Das
- Department of Epidemiology and Biostatistics, MRC Health Protection Agency (HPE) Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - M De Iorio
- Department of Statistical Science, University College London, London, UK
| | - L Coin
- Department of Epidemiology and Biostatistics, MRC Health Protection Agency (HPE) Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - M Ala-Korpela
- SAHMRI, School of Biological Sciences, University of Adelaide, Adelaide, Australia.,Biocenter Oulu, University of Oulu, Oulu, Finland.,NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Computational Medicine, School of Social and Community Medicine and the Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - M-R Järvelin
- Department of Epidemiology and Biostatistics, MRC Health Protection Agency (HPE) Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.,Center for Life-Course Health Research, Northern Finland Cohort Center, Faculty of Medicine, University of Oulu, Oulu, Finland.,Biocenter Oulu, University of Oulu, Oulu, Finland.,Unit of Primary Care, Oulu University Hospital, Oulu, Finland
| | - S Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
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44
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Ollila MM, West S, Keinänen-Kiukaanniemi S, Jokelainen J, Auvinen J, Puukka K, Ruokonen A, Järvelin MR, Tapanainen JS, Franks S, Piltonen TT, Morin-Papunen LC. Overweight and obese but not normal weight women with PCOS are at increased risk of Type 2 diabetes mellitus-a prospective, population-based cohort study. Hum Reprod 2016; 32:423-431. [PMID: 28031324 DOI: 10.1093/humrep/dew329] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/29/2016] [Accepted: 12/16/2016] [Indexed: 12/15/2022] Open
Abstract
STUDY QUESTION What are the respective roles of polycystic ovary syndrome (PCOS), long-term weight gain and obesity for the development of prediabetes or Type 2 diabetes mellitus (T2DM) by age 46 years? SUMMARY ANSWER The risk of T2DM in women with PCOS is mainly due to overweight and obesity, although these two factors have a synergistic effect on the development of T2DM. WHAT IS KNOWN ALREADY PCOS is associated with an increased risk of prediabetes and T2DM. However, the respective roles of PCOS per se and BMI for the development of T2DM have remained unclear. STUDY DESIGN, SIZE, DURATION In a prospective, general population-based follow-up birth cohort 1966 (n = 5889), postal questionnaires were sent at ages 14 (95% answered), 31 (80% answered) and 46 years (72% answered). Questions about oligoamenorrhoea and hirsutism were asked at age 31 years, and a question about PCOS diagnosis at 46 years. Clinical examination and blood sampling were performed at 31 years in 3127 women, and at 46 years in 3280 women. A 2-h oral glucose tolerance test (OGTT) was performed at 46 years of age in 2780 women. PARTICIPANTS/MATERIALS, SETTING, METHODS Women reporting both oligoamenorrhoea and hirsutism at age 31 years and/or diagnosis of PCOS by 46 years were considered as women with PCOS (n = 279). Women without any symptoms at 31 years and without PCOS diagnosis by 46 years were considered as controls (n = 1577). The level of glucose metabolism was classified according to the results of the OGTT and previous information of glucose metabolism status from the national drug and hospital discharge registers. MAIN RESULTS AND THE ROLE OF CHANCE PCOS per se significantly increased the risk of T2DM in overweight/obese (BMI ≥ 25.0 kg/m2) women with PCOS when compared to overweight/obese controls (odds ratio: 2.45, 95% CI: 1.28-4.67). Normal weight women with PCOS did not present with an increased risk of prediabetes or T2DM. The increase in weight between ages 14, 31 and 46 years was significantly greater in women with PCOS developing T2DM than in women with PCOS and normal glucose tolerance, with the most significant increase occurring in early adulthood (between 14 and 31 years: median with [25%; 75% quartiles]: 27.25 kg [20.43; 34.78] versus 13.80 kg [8.55; 20.20], P < 0.001). LIMITATIONS, REASONS FOR CAUTION The diagnosis of PCOS was based on self-reporting, and the questionnaire at 46 years did not distinguish between polycystic ovaries only in ultrasonography and the syndrome. Ovarian ultrasonography was not available to aid the diagnosis of PCOS. WIDER IMPLICATIONS OF THE FINDINGS These results emphasize weight management already during adolescence and early adulthood to prevent the development of T2DM in women with PCOS, as the period between 14 and 31 years seems to be a crucial time-window during which the women with PCOS who are destined to develop T2DM by 46 years of age experience a dramatic weight gain. Furthermore, our results support the view that, particularly in times of limited sources of healthcare systems, OGTT screening should be targeted to overweight/obese women with PCOS rather than to all women with PCOS. STUDY FUNDING/COMPETING INTERESTS Finnish Medical Foundation; North Ostrobothnia Regional Fund; Academy of Finland (project grants 104781, 120315, 129269, 1114194, 24300796, Center of Excellence in Complex Disease Genetics and SALVE); Sigrid Juselius Foundation; Biocenter Oulu; University Hospital Oulu and University of Oulu (75617); Medical Research Center Oulu; National Institute for Health Research (UK); National Heart, Lung, and Blood Institute (grant 5R01HL087679-02) through the STAMPEED program (1RL1MH083268-01); National Institute of Health/National Institute of Mental Health (5R01MH63706:02); ENGAGE project and grant agreement HEALTH-F4-2007-201413; EU FP7 EurHEALTHAgeing-277849 European Commission and Medical Research Council, UK (G0500539, G0600705, G1002319, PrevMetSyn/SALVE) and Medical Research Center, Centenary Early Career Award. The authors have no conflicts of interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M M Ollila
- Department of Obstetrics and Gynaecology, Oulu University Hospital, University of Oulu, Medical Research Center Oulu and PEDEGO Research Unit, FI-90029, OYS, Oulu, Finland
| | - S West
- Department of Obstetrics and Gynaecology, Oulu University Hospital, University of Oulu, Medical Research Center Oulu and PEDEGO Research Unit, FI-90029, OYS, Oulu, Finland
| | - S Keinänen-Kiukaanniemi
- Center for Life Course Health Research, University of Oulu, FI-90014, Oulu, Finland.,Unit of Primary Health Care, Oulu University Hospital, FI-90220, Oulu, Finland
| | - J Jokelainen
- Center for Life Course Health Research, University of Oulu, FI-90014, Oulu, Finland.,Unit of Primary Health Care, Oulu University Hospital, FI-90220, Oulu, Finland
| | - J Auvinen
- Center for Life Course Health Research, University of Oulu, FI-90014, Oulu, Finland.,Unit of Primary Health Care, Oulu University Hospital, FI-90220, Oulu, Finland
| | - K Puukka
- NordLab Oulu, Department of Clinical Chemistry, Oulu University Hospital, University of Oulu and Medical Research Center Oulu, FI-90220, Oulu, Finland
| | - A Ruokonen
- NordLab Oulu, Department of Clinical Chemistry, Oulu University Hospital, University of Oulu and Medical Research Center Oulu, FI-90220, Oulu, Finland
| | - M-R Järvelin
- Center for Life Course Health Research, University of Oulu, FI-90014, Oulu, Finland.,Department of Children, Young People and Families, National Institute for Health and Welfare, FI-90101, Oulu, Finland.,Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment & Health, School of Public Health, Imperial College London, W2 1PG, London, UK
| | - J S Tapanainen
- Department of Obstetrics and Gynaecology, Oulu University Hospital, University of Oulu, Medical Research Center Oulu and PEDEGO Research Unit, FI-90029, OYS, Oulu, Finland.,Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, FI-00014, Helsinki, Finland
| | - S Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, W12 0NN, London, UK
| | - T T Piltonen
- Department of Obstetrics and Gynaecology, Oulu University Hospital, University of Oulu, Medical Research Center Oulu and PEDEGO Research Unit, FI-90029, OYS, Oulu, Finland
| | - L C Morin-Papunen
- Department of Obstetrics and Gynaecology, Oulu University Hospital, University of Oulu, Medical Research Center Oulu and PEDEGO Research Unit, FI-90029, OYS, Oulu, Finland
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45
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Rosenfield RL, Ehrmann DA. The Pathogenesis of Polycystic Ovary Syndrome (PCOS): The Hypothesis of PCOS as Functional Ovarian Hyperandrogenism Revisited. Endocr Rev 2016; 37:467-520. [PMID: 27459230 PMCID: PMC5045492 DOI: 10.1210/er.2015-1104] [Citation(s) in RCA: 689] [Impact Index Per Article: 86.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 07/20/2016] [Indexed: 02/06/2023]
Abstract
Polycystic ovary syndrome (PCOS) was hypothesized to result from functional ovarian hyperandrogenism (FOH) due to dysregulation of androgen secretion in 1989-1995. Subsequent studies have supported and amplified this hypothesis. When defined as otherwise unexplained hyperandrogenic oligoanovulation, two-thirds of PCOS cases have functionally typical FOH, characterized by 17-hydroxyprogesterone hyperresponsiveness to gonadotropin stimulation. Two-thirds of the remaining PCOS have FOH detectable by testosterone elevation after suppression of adrenal androgen production. About 3% of PCOS have a related isolated functional adrenal hyperandrogenism. The remaining PCOS cases are mild and lack evidence of steroid secretory abnormalities; most of these are obese, which we postulate to account for their atypical PCOS. Approximately half of normal women with polycystic ovarian morphology (PCOM) have subclinical FOH-related steroidogenic defects. Theca cells from polycystic ovaries of classic PCOS patients in long-term culture have an intrinsic steroidogenic dysregulation that can account for the steroidogenic abnormalities typical of FOH. These cells overexpress most steroidogenic enzymes, particularly cytochrome P450c17. Overexpression of a protein identified by genome-wide association screening, differentially expressed in normal and neoplastic development 1A.V2, in normal theca cells has reproduced this PCOS phenotype in vitro. A metabolic syndrome of obesity-related and/or intrinsic insulin resistance occurs in about half of PCOS patients, and the compensatory hyperinsulinism has tissue-selective effects, which include aggravation of hyperandrogenism. PCOS seems to arise as a complex trait that results from the interaction of diverse genetic and environmental factors. Heritable factors include PCOM, hyperandrogenemia, insulin resistance, and insulin secretory defects. Environmental factors include prenatal androgen exposure and poor fetal growth, whereas acquired obesity is a major postnatal factor. The variety of pathways involved and lack of a common thread attests to the multifactorial nature and heterogeneity of the syndrome. Further research into the fundamental basis of the disorder will be necessary to optimally correct androgen levels, ovulation, and metabolic homeostasis.
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Affiliation(s)
- Robert L Rosenfield
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, The University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637
| | - David A Ehrmann
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, The University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637
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46
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Cirillo PM, Wang ET, Cedars MI, Chen LM, Cohn BA. Irregular menses predicts ovarian cancer: Prospective evidence from the Child Health and Development Studies. Int J Cancer 2016; 139:1009-17. [PMID: 27082375 PMCID: PMC6917033 DOI: 10.1002/ijc.30144] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 02/12/2016] [Accepted: 03/18/2016] [Indexed: 01/07/2023]
Abstract
We tested the hypothesis that irregular menstruation predicts lower risk for ovarian cancer, possibly due to less frequent ovulation. We conducted a 50-year prospective study of 15,528 mothers in the Child Health and Development Studies cohort recruited from the Kaiser Foundation Health Plan from 1959 to 1966. Irregular menstruation was classified via medical record and self-report at age 26. We identified 116 cases and 84 deaths due to ovarian cancer through 2011 via linkage to the California Cancer Registry and Vital Statistics. Contrary to expectation, women with irregular menstrual cycles had a higher risk of ovarian cancer incidence and mortality over the 50-year follow-up. Associations increased with age (p <0.05). We observed a 2-fold increased incidence and mortality by age 70 (95% confidence interval [CI] = 1.1, 3.4) rising to a 3-fold increase by age 77 (95% CI = 1.5, 6.7 for incidence; 95% CI = 1.4, 5.9 for mortality). We also found a 3-fold higher risk of mortality for high-grade serous tumors (95% CI = 1.3, 7.6) that did not vary by age. This is the first prospective study to show an association between irregular menstruation and ovarian cancer-we unexpectedly found higher risk for women with irregular cycles. These women are easy to identify and many may have polycystic ovarian syndrome. Classifying high-risk phenotypes such as irregular menstruation creates opportunities to find novel early biomarkers, refine clinical screening protocols and potentially develop new risk reduction strategies. These efforts can lead to earlier detection and better survival for ovarian cancer.
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Affiliation(s)
- Piera M. Cirillo
- Child Health and Development Studies of the Public Health Institute, Berkeley, CA
| | - Erica T. Wang
- Cedars Sinai Medical Center, Obstetrics and Gynecology, Los Angeles, CA
| | - Marcelle I. Cedars
- UCSF Medical Center at Mount Zion, Center for Reproductive Health, San Francisco, CA
| | - Lee-may Chen
- UCSF Helen Diller Family Comprehensive Cancer Center, Department of Obstetrics, Gynecology and Reproductive Services, San Francisco, CA
| | - Barbara A. Cohn
- Child Health and Development Studies of the Public Health Institute, Berkeley, CA
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47
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Pertynska-Marczewska M, Diamanti-Kandarakis E, Zhang J, Merhi Z. Advanced glycation end products: A link between metabolic and endothelial dysfunction in polycystic ovary syndrome? Metabolism 2015; 64:1564-73. [PMID: 26386695 DOI: 10.1016/j.metabol.2015.08.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 08/16/2015] [Accepted: 08/17/2015] [Indexed: 01/07/2023]
Abstract
Polycystic ovary syndrome (PCOS), a heterogeneous syndrome of reproductive and metabolic alterations, is associated with increased long-term risk of cardiovascular complications. This phenomenon has been linked to an increase in oxidative stress and inflammatory markers. Advanced glycation end products (AGEs) are pro-inflammatory molecules that trigger a state of intracellular oxidative stress and inflammation after binding to their cell membrane receptors RAGE. The activation of the AGE-RAGE axis has been well known to play a role in atherosclerosis in both men and women. Women with PCOS have systemic chronic inflammatory condition even at the ovarian level as represented by elevated levels of serum/ovarian AGEs and increased expression of the pro-inflammatory RAGE in ovarian tissue. Data also showed the presence of sRAGE in the follicular fluid and its potential protective role against the harmful effect of AGEs on ovarian function. Thus, whether AGE-RAGE axis constitutes a link between metabolic and endothelial dysfunction in women with PCOS is addressed in this review. Additionally, we discuss the role of hormonal changes observed in PCOS and how they are linked with the AGE-RAGE axis in order to better understand the nature of this complex syndrome whose consequences extend well beyond reproduction.
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Affiliation(s)
| | - Evanthia Diamanti-Kandarakis
- Department of Medicine, Endocrine Unit, Medical School University of Athens, Mikras Asias 75, Goudi 115002D27, Athens, Greece.
| | - John Zhang
- Reproductive Medicine, New Hope Fertility Center, 4 Columbus Circle, New York, NY, USA.
| | - Zaher Merhi
- Department of Obstetrics and Gynecology, Division of Reproductive Biology, NYU School of Medicine, 180 Varick Street, sixth floor, New York, NY, USA.
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Mahalingaiah S, Diamanti-Kandarakis E. Targets to treat metabolic syndrome in polycystic ovary syndrome. Expert Opin Ther Targets 2015; 19:1561-74. [PMID: 26488852 DOI: 10.1517/14728222.2015.1101067] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Metabolic syndrome is comprised of a combination of the following states: increased insulin resistance, dyslipidemia, cardiovascular disease, and increased abdominal obesity. Women with polycystic ovary syndrome (PCOS) have an increased risk of developing metabolic syndrome over the course of their lives. Metabolic syndrome increases risk of major cardiovascular events, morbidity, quality of life, and overall health care costs. Though metabolic syndrome in women with PCOS is an area of great concern, there is no effective individual medical therapeutic to adequately treat this issue. AREAS COVERED This article will review key aspects of metabolic syndrome in PCOS. We will discuss classic and novel therapeutics to address metabolic syndrome in women with PCOS. We will conclude with the importance of developing strategic interventions to increase the compliance to lifestyle and dietary modification, in addition to appreciation of the emerging pharmaceutical therapeutics available. EXPERT OPINION Innovation in lifestyle modification, including diet, exercise, with and without dedicated stress reduction techniques is the future in treatment of metabolic syndrome in PCOS. Application of novel interventions, such as group medical care, may improve future adherence to lifestyle modification recommendations, in addition to or in combination with pharmaceutical therapeutics.
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Affiliation(s)
- Shruthi Mahalingaiah
- a Department of Obstetrics and Gynecology , Boston University School of Medicine , Boston , MA 02118 , USA
| | - Evanthia Diamanti-Kandarakis
- b Department of Endocrinology, Diabetes & Metabolism , University of Athens Medical School , Athens 11521 , Greece
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Ramezani Tehrani F, Montazeri SA, Hosseinpanah F, Cheraghi L, Erfani H, Tohidi M, Azizi F. Trend of Cardio-Metabolic Risk Factors in Polycystic Ovary Syndrome: A Population-Based Prospective Cohort Study. PLoS One 2015; 10:e0137609. [PMID: 26360602 PMCID: PMC4567354 DOI: 10.1371/journal.pone.0137609] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/19/2015] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To see the changes of cardio-metabolic risk factors overtime in polycystic ovary syndrome vs. control women. METHODS This study was conducted on 637 participants (85 PCOS and 552 control reproductive aged, 18-45 years) of Tehran Lipid and Glucose Study (TLGS), an ongoing population-based cohort study with 12 years of follow-up. The cardiovascular risk factors of these groups were assessed in three-year intervals using standard questionnaires, history taking, anthropometric measures, and metabolic/endocrine evaluation. Generalized estimating equation was used to analyze the data. RESULTS Overall mean of insulin (3.55, CI: 0.66-6.45), HOMA-IR (0.63, CI: 0.08-1.18), and HOMA-β (45.90, CI: 0.86-90.93) were significantly higher in PCOS than in healthy women after adjustment for age, BMI, and baseline levels. However, the negative interaction (follow-up years × PCOS status) of PCOS and normal women converged overtime. Comparing third follow-up with first, insulin and HOMA-IR decreased 10.6% and 5%, respectively in PCOS women; and increased 6.7% and 14.6%, respectively in controls (P<0.05). The results did not show any significant result for other cardio-metabolic variables including WC, lipid profile, FPG, 2-h PG, SBP, and DBP. CONCLUSION While the insulin level and insulin resistance rate were higher in reproductive aged PCOS than in healthy women, the difference of these risk factors decreased overtime. Thus, the metabolic consequences of PCOS women in later life may be lower than those initially anticipated.
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Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Montazeri
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Student of Public Health, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Cheraghi
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hadi Erfani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Student of Public Health, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Calderon-Margalit R, Siscovick D, Merkin SS, Wang E, Daviglus ML, Schreiner PJ, Sternfeld B, Williams OD, Lewis CE, Azziz R, Schwartz SM, Wellons MF. Prospective association of polycystic ovary syndrome with coronary artery calcification and carotid-intima-media thickness: the Coronary Artery Risk Development in Young Adults Women's study. Arterioscler Thromb Vasc Biol 2014; 34:2688-94. [PMID: 25359859 DOI: 10.1161/atvbaha.114.304136] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To study the independent associations of polycystic ovary syndrome (PCOS), and its 2 components, hyperandrogenism and anovulation, with coronary artery calcification (CAC) and carotid artery intima-media thickness (IMT). APPROACH AND RESULTS At the year 20 of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based multicenter cohort of young adults, women (mean age, 45 years) with information on menses and hirsutism in their twenties were assessed for CAC (n=982) and IMT (n=988). We defined PCOS as women who had both irregular menses and hyperandrogenism (n=55); isolated oligomenorrhea (n=103) as women who only had irregular menses; and isolated hyperandrogenism (n=156) as women who had either hirsutism or increased testosterone levels. Logistic regressions and general linear models were used to estimate the associations between components of PCOS and subclinical CVD. The prevalence of CAC was 10.3% overall. Women with PCOS had a multivariable adjusted odds ratio of 2.70 (95% confidence interval, 1.31-5.60) for CAC. Women with either isolated oligomenorrhea or isolated hyperandrogenism had no increased risk of CAC when compared with unexposed women. Women with PCOS had significantly increased bulb and internal carotid-IMT measurements; however, no significant differences were noted in bulb or internal carotid artery IMT among women with either isolated oligomenorrhea or isolated hyperandrogenism when compared with unexposed women. There were no differences in common carotid-IMT among the 4 study groups. CONCLUSIONS In this study, women with PCOS, manifested as both anovulation and hyperandrogenism, but not women with one of these manifestations alone, were at increased risk for the development of subclinical CVD.
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Affiliation(s)
- Ronit Calderon-Margalit
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.).
| | - David Siscovick
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Sharon S Merkin
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Erica Wang
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Martha L Daviglus
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Pamela J Schreiner
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Barbara Sternfeld
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - O Dale Williams
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Cora E Lewis
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Ricardo Azziz
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Stephen M Schwartz
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
| | - Melissa F Wellons
- From the Department of Epidemiology and Biostatistics, Hadassah-Hebrew University Braun School of Public Health, Jerusalem, Israel (R.C.-M); New York Academy of Medicine, New York (D.S.); Division of Geriatrics, The David Geffen School of Medicine at UCLA, University of California-Los Angeles (S.S.M.); Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA (E.W.); Institute for Minority Health Research, University of Illinois at Chicago (M.L.D.); School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente North California, Oakland (B.S.); Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami (O.D.W.); Department of Medicine, University of Alabama at Birmingham (C.E.L.); Georgia Regents University, Augusta (R.A.); Department of Epidemiology, University of Washington, Seattle (S.M.S.); and Department of Medicine, Vanderbilt University, Franklin, TN (M.F.W.)
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